Efficacy of methylene blue-mediated antimicrobial photodynamic therapy on clinical and radiographic outcomes among patients with periodontal diseases: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: This study aimed to assess the influence of methylene blue (MB)-mediated adjunctive antimicrobial photodynamic therapy (aPDT) when compared to conventional mechanical debridement (MD) alone on periodontal clinical and radiographic outcomes among periodontitis patients. METHODS: Randomized clinical trials (RCTs) were incorporated by conducting an electronic search in Web of Science, Scopus, and PubMed for articles published in English up to August 2023 to address the following focused question based on the PICO format: "Whether the application of MB-mediated aPDT as an adjunctive to MD (Intervention) leads to improved periodontal clinical and/or radiographic outcomes (Outcome) among participants with and without periodontal diseases (Population) as compared to MD alone (Conparison)". The risk of bias (RoB) of the included studies was assessed using the modified Jadad scale. A meta-analysis was conducted, and it included the presentation of the standard mean difference (SMD) along with a 95 % confidence interval (CI). RESULTS: In total, 11 studies were included in this systematic review and meta-analysis. The meta-analysis demonstrated statistically significant improvements in periodontal plaque index (SMD: -0.72 % [95 % CI: -0.99 % to -0.45 %]; p<0.00001), probing depth (SMD: -0.38 % [95 % CI: -0.57 % to -0.19 %; p<0.00001), and bleeding on probing (SMD: -0.44 % [95 % CI: -0.68 % to -0.20 %]; p = 0.0003) scores at the final follow-up visit after the application of MB-mediated aPDT in comparison with MD alone. Nevertheless, there was no statistically significant difference was observed in periodontal clinical attachment level values (SMD: -0.01 % [95 % CI: -0.21 % to 0.19 %]; p = 0.95) between the control group and the experimental group. Six studies achieved a low RoB, five were rated as having medium RoB, while no study received a high RoB. CONCLUSION: MB-mediated aPDT, when used as an adjunct to conventional MD contributes to the improvement of periodontal clinical outcomes including PI, PD, and BOP in patients with periodontitis.

Efficacy of Adjunctive Fotoenticine Photodynamic Therapy and Sapindus mukorossi Therapy on Clinical, Radiographic, and Cytokine Profile of Diabetics with Peri-Implantitis.

Objective: To evaluate effectiveness of Fotoenticine (FTC)-mediated photodynamic therapy (PDT) and Sapindus mukorossi (SM) as adjunct to mechanical debridement (MD) on peri-implant clinical parameters and levels of proinflammatory cytokines among diabetics. Background: FTC has exhibited robust photodynamic impact against Streptococcus mutans (i.e., an established caries-associated bacterium); however, its efficacy against periodontal pathogens is not known. Methods: One hundred six diabetics with peri-implantitis were randomly categorized into three groups: Group I consisted of 37 participants who were treated with only MD; group II comprised 35 participants who were treated with FTC-mediated PDT, in addition to MD; and group III consisted of 34 participants who were treated with SM, in addition to MD. Peri-implant clinical parameters [plaque index (PI), bleeding on probing (BOP), and probing depth (PD)] and radiographic outcomes [crestal bone loss (CBL)] (PI, BOP, and PD), together with peri-implant sulcular fluid (PISF) interleukin (IL)-1ß and IL-6 levels were measured at baseline and 6-month follow-up. Results: In group I (n = 37; 24 males +13 females), group II (n = 35; 20 males +15 females), and group III (n = 34; 17 males +17 females), the mean age of participants was 54.3 ± 4.6, 52.0 ± 5.5, and 50.8 ± 4.5 years, respectively. Significant improvement was observed in the scores of peri-implant PI (p = 0.01), BOP (p = 0.01), and PD (p = 0.02) at the 6-month follow-up among all study groups. Significant improvement in peri-implant CBL among group I subjects at 6-month follow-up compared to baseline (p < 0.05) was observed. PISF levels of IL-1ß and IL-6 improved at 6 months. Conclusions: As an adjunct to conventional MD, FTC-mediated PDT and SM might be used as potential therapeutic modalities among diabetics with peri-implantitis.

Influence of adjunctive non-surgical peri­implant therapy on clinical and salivary cytokine profile in obese patients.

AIM: The present study aimed to evaluate the impact of Photodynamic therapy (PDT) and Er,Cr:YSGG laser (ECL) adjunct to nonsurgical mechanical debridement (NSMD) in comparison to conventional NSMD in overweight individuals with peri­implant disease on peri­implant inflammatory parameters and cytokine levels of IL-6 and TNF-α in Peri-implant crevicular fluid (PICF) MATERIALS AND METHODS: Recruitment of volunteers was performed from the outpatient department according to predefined inclusion and exclusion criteria. Group 1 consisted of obese participants who underwent peri­implant mechanical debridement (MD); group 2, obese participants who experienced MD adjunct to ECL, and in group 3, obese participants were treated with MD and adjunct PDT. Clinical periodontal parameters, plaque index (PI), bleeding index (BI) and probing depth (PD) along with crestal bone loss (CBL) were assessed at baseline, 3 months, and 6 months. PICF was collected to evaluate the levels of IL-6 and TNF-α. Kruskal-Wallis and Bonferroni post hoc test were employed for the comparison of peri­implant inflammatory parameters and PICF cytokine profiles among the study groups. RESULTS: Clinical peri­implant parameters (PI, BI and PD) at baseline among subjects in group 1, group 2 and group 3 were comparable (p > 0.05). At 3 months follow up, mean scores of peri­implant PI, BI, and PD (P <0.05) in group 1 (control) were significantly higher compared to group 2 (ECL) and 3 (PDT) (p < 0.05). At 6 months follow-up, PI and BI mean scores among groups 1, 2, and 3 were comparable (p>0.05). At 6 months participants in groups 2 and 3 noted significant difference (p<0.05) compared to baseline with no difference noted in the control group (p>0.05). CONCLUSION: Photodynamic therapy and Er, Cr: YSGG adjunct to NSMD demonstrated significant improvement in peri­implant inflammatory parameters in obese individuals. Multicentric clinical trials are suggested to extrapolate the findings of the present study.

Longitudinal assessment of clinical and radiographic periimplant status around narrow and regular diameter implants placed in cigarette-smokers and nonsmokers.

BACKGROUND: To date, no clinical investigation has assessed the clinical and radiographic indices around narrow diameter implants (NDIs) and regular diameter implants (RDIs) in individuals with cigarette smoking habit and nonsmokers. OBJECTIVE: To estimate and compare the clinical and radiographic indices around NDIs (< 3.3 mm) and RDIs placed in cigarette smokers (CS) and nonsmokers (NS). MATERIALS AND METHODS: Eighty-six patients requiring implant surgery in the anterior mandible were divided into two groups (39 CS and 43 NS). Patients were further categorized into two subgroups on the basis of implant diameter: (a) patients with NDIs (3.3 mm) and (b) patients with RDIs (4.1 mm). Clinical indices evaluating plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were recorded at 18 and 36 months of follow-up. Digital periapical radiographs were studied to evaluate crestal bone levels (CBL) incorporating in a specialized software and examined on a calibrated computer display screen with the help of an image analyzer. RESULTS: The mean age of patients in CS group and NS group was 44.6 and 42.5 years, respectively. There was no statistically significant difference in the overall mean scores of PI, PD, and CBL around NDIs and RDIs among CS and NS patients at 18 and 36 months of follow-up. However, there was a statistically significant difference only in the overall mean BOP around NDIs and RDIs among CS and NS patients at 18 and 36 months of follow-up. CONCLUSION: The findings of the current study suggests that NDIs can show reliable clinical stability and radiographic bone levels as RDIs placed in CS and NS, with the support of strict oral hygiene protocols.

Antimicrobial efficacy of photodynamic therapy on dental implant surfaces: A systematic review of in vitro studies.

BACKGROUND: To systematically review the literature regarding the antimicrobial effects of photodynamic therapy (PDT) on multi-bacterial species and the possible surface alterations of dental implants as a result of PDT. METHODS: The addressed focused question was: "Does PDT show antimicrobial efficacy against multi-bacterial species colonization and result in surface alteration on dental implants?" Electronic databases including MEDLINE and EMBASE up to and including December 2018 were searched. RESULTS: Seven studies were included. Two studies used a total of 110 titanium dental implants, while 1 study included a total of 72 zirconia dental implants. Three studies investigated the antimicrobial PDT effects on titanium discs, while 1 study used titanium plates with germanium prisms. All in-vitro studies used diode laser. Energy fluence was reported only in 2 studies. Power output and density were 100 mW (mW) and 150 mW cm-2, respectively. All in-vitro studies reported the multibacterial species outcomes after the application of antimicrobial PDT. All studies showed a significant reduction in the bacterial load. Only two studies reported the outcomes of microstructural changes on the titanium surface, in which both studies did not report any significant alterations on the titanium implants or discs with the application of PDT. CONCLUSION: This systematic review demonstrated significant reduction in the bacterial load but inconclusive findings regarding structural alterations on the titanium surface with the use of PDT. The results of this review should be considered preliminary and further in-vitro studies with standardized laser parameters are needed to obtain strong conclusions.

Clinical indices and local levels of inflammatory biomarkers in per-implant health of obese and nonobese individuals.

BACKGROUND: Obesity seem to regulate peri-implant health. It is proposed that peri-implant crevicular fluid (PICF) levels of interleukin (IL)-1ß and IL-6 are higher in obese as compared to nonobese individuals. OBJECTIVE: The purpose of the present clinico-laboratory study is to estimate and compare the clinical and radiographic indices and PICF levels of IL-1ß and IL-6 among obese and nonobese patients. MATERIALS AND METHODS: Fifty patients were divided into two groups (25 obese with ≥27.5 kg/m2 and 25 nonobese with <27.5 kg/m2 individuals). Clinical indices for both periodontal and peri-implant evaluating plaque index (PI), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL), and crestal bone loss (CBL) were recorded around teeth and implants. PICF was collected and assessed for the levels of IL-1ß and IL-6 using enzyme-linked immunosorbent assay. RESULTS: A significant difference was observed in PI and BOP around natural teeth and implants in obese patients, respectively (P < .05). CBL was found to be significantly higher among obese as compared to nonobese patients (P = .022). Peri-implant and periodontal PD was higher in obese as compared to nonobese but did not reach statistical significance. Levels of IL-1ß and IL-6 were statistically significantly higher among obese patients as compared to nonobese (P = .001). Pearson correlation analysis showed IL-1ß was positively correlated with CBL (P = .0079), whereas IL-6 showed positive correlation with both BOP (P = .0019) and CBL (P = .015) among obese patients. CONCLUSIONS: Clinical peri-implant parameters were worse and proinflammatory biomarkers were significantly higher in obese patients compared with nonobese subjects. The findings of the present study suggests that increased proinflammatory biomarkers in PICF of obese patients may modulate peri-implant inflammation around dental implants.

Clinical and radiographic periodontal status and whole salivary cotinine, IL-1ß and IL-6 levels in cigarette- and waterpipe-smokers and E-cig users.

The aim was to compare the clinical (plaque index [PI], bleeding on probing [BOP], probing pocket depth [PPD] and clinical attachment loss [CAL]) and radiographic (marginal bone loss [MBL]) periodontal parameters and whole salivary cotinine, interleukin (IL)-1ß and IL-6 levels among cigarette-smokers, waterpipe-smokers, E-cig users and never-smokers. In total, 154 male individuals (39 cigarette-smokers, 40 waterpipe-smokers, 37 E-cig users and 38 never-smokers) were included. Full mouth PI, BOP, PPD and CAL were measured on all teeth (excluding third molars); and MBL was measured in digital intra-oral radiographs. Unstimulated whole salivary flow rate (UWSFR) and whole salivary cotinine, IL-1ß and IL-6 levels were measured. Group comparisons were performed using one way analysis of variance and Bonferroni post-hoc tests. P-values less than 0.05 were considered statistically significant. There was no difference in UWSFR among the groups. Cotinine levels were significantly higher among cigarette- (P < 0.001) and waterpipe-smokers (P < 0.001) and E-cig users (P < 0.001) than never-smokers. IL-1ß (P < 0.01) and IL-6 (P < 0.01) levels were significantly higher among cigarette- and waterpipe-smokers than E-cig users and never-smokers. There was no difference in PPD, CAL, mesial and distal MBL and whole salivary IL-1ß and IL-6 levels among E-cig users and never-smokers. In conclusion, clinical and radiographic parameters of periodontal inflammation were poorer in cigarette and waterpipe smokers than E-cig users and never-smokers; and whole salivary cotinine levels were similar in all groups. Whole salivary IL-1ß and IL-6 levels were higher in cigarette- and waterpipe-smokers than E-cig users and never-smokers.

Peri-implant soft tissue status and crestal bone levels around adjacent implants placed in patients with and without type-2 diabetes mellitus: 6 years follow-up results.

BACKGROUND: The long-term success and survival of dental implants type-2 diabetic subjects is debatable. PURPOSE: The present 6 years' follow-up prospective clinical study compared the peri-implant soft tissue status and crestal bone loss (CBL) around adjacent implants placed among type-2 diabetic and nondiabetic subjects. MATERIALS AND METHODS: Type-2 diabetic (Group-1) and nondiabetic individuals (Group-2) with adjacent dental implants were included. Hemoglobin A1c (HbA1c) levels were recorded; and a questionnaire was used to collect demographic information. Information regarding implant dimensions, duration in function, loading protocol, and type of restoration was recorded. Peri-implant bleeding-on-probing (BOP), plaque index (PI), probing depth (PD), and mesial and distal CBL were measured. P < .05 were considered statistically significant. RESULTS: Eighty-six male participants (44 in Group-1 and 42 in Group-2) were included. The mean age of individuals in groups 1 and 2 were 57.6 ± 5.5 and 61.6 ± 4.3 years, respectively. In Group-1, the mean duration of type-2 diabetes was 10.1 ± 3.5 years. A family history of diabetes was more often reported by individuals in Group-1 than Group-2. In groups 1 and 2, 44 and 42 pairs of adjacent implants, respectively were placed in the regions of missing premolars and molars in both arches. All implants were delayed loaded and were fixed with non-splinted screw-retained restorations. In groups 1 and 2, tooth-brushing twice daily was reported by 79.5% and 85.7% individuals, respectively. There was no difference in peri-implant PI, BOP, PD, mesial and distal CBL and HbA1c levels among individuals in groups 1 and 2. CONCLUSION: Adjacent implants can remain esthetically and functionally stable in type 2 diabetic patients in a manner similar to healthy individuals provided glycemic levels are strictly controlled and maintained.

Effect of antimicrobial photodynamic therapy in open flap debridement in the treatment of peri-implantitis: A randomized controlled trial.

BACKGROUND: To evaluate the effects of single application of antimicrobial photodynamic therapy (aPDT) as an adjunct to open flap debridement (OFD) and OFD alone in patients with peri-implantitis (PI). MATERIALS AND METHODS: Twenty four patients with PI were divided into 2 groups receiving aPDT with OFD and OFD alone respectively. Peri-implant plaque index (PI), bleeding on probing (BOP), pocket depth (PD) and marginal bone level (MBL) were assessed at baseline, 6 and 12 months post-therapy. Digital periapical radiographs were taken and viewed on a calibrated computer screen using a software for the assessment of MBL. Only single implant from each patient was included in the study protocol (intent to treat analysis). RESULTS: At baseline, peri-implant PI, BOP, PD and MBL were comparable among individuals in aPDT and OFD groups. All patients had localized peri-implant PD ≥5 mm. At 6 months, aPDT and OFD significantly reduced peri-implant PI, BOP, PD and MBL. Similarly, after 12 months post-therapy, both groups reduced PI, BOP, PD and MBL. However, there was no significant difference between aPDT and OFD groups over time. CONCLUSION: Single application of aPDT as an adjunct to OFD does not provide additional benefit in improving clinical and radiographic peri-implant parameters in peri-implantitis.

Effectiveness of adjunctive antimicrobial photodynamic therapy in reducing peri-implant inflammatory response in individuals vaping electronic cigarettes: A randomized controlled clinical trial.

BACKGROUND: There are no studies that have assessed the effectiveness of antimicrobial photodynamic therapy (aPDT) in reducing peri-implant inflammatory response in individuals vaping electronic cigarettes (e-cigs). This study explored the effectiveness of aPDT as an adjunct to mechanical debridement (MD) in the treatment of peri-implant mucositis (p-iM) in individuals vaping e-cigs. METHODS: Vaping individuals with p-iM were divided into 2 groups: (a) Group-I: receiving MD with aPDT (test group); and (b) Group-II: MD only (control group). Peri-implant inflammatory parameters including plaque index (PI), bleeding on probing (BoP), and pocket depth (PD) were assessed at baseline and 12-weeks follow-up. Inter- and intra-group comparisons were made using Mann-Whitney U test and Wilcoxon signed ranks test. P-value < 0.05 was considered significant. RESULTS: Thirty-eight male patients (20 in Group-I and 18 in Group-II) were included. The mean age of vaping individuals in groups I and II were 33.6 ±â€¯2.8 and 35.4 ±â€¯2.1 years, respectively. Mean daily frequency of vaping e-cigs in groups I and II was 7.3 ±â€¯0.9 and 5.9 ±â€¯1.0 whereas mean duration of vaping e-cigs was 4.8 ±â€¯1.5 and 4.1 ±â€¯1.3 years respectively. There was no significant difference between groups at baseline. There was significant improvement in PI (p < 0.001) and PD (p < 0.001) at 12-weeks follow-up with respect to the baseline visit in both groups. There was a significant reduction in PI (p < 0.001) and PD (p < 0.001) for group-I as compared to group-II at follow-up. There was no statistically significant difference for BoP between groups at follow-up. CONCLUSION: Antimicrobial PDT is more effective compared to MD alone in the treatment of p-iM in individuals vaping e-cigs. The findings of the present study should be considered preliminary and interpreted with caution. Further randomized clinical trials should be performed in order to obtain strong conclusions.

Comparison of Clinical, Radiographic, and Immunologic Inflammatory Parameters around Crestally and Subcrestally Placed Dental Implants: 5-Year Retrospective Results.

PURPOSE: To compare changes in clinical (bleeding on probing [BOP] and probing pocket depth [PPD]), radiographic (crestal bone loss [CBL]), and immunologic inflammatory (interleukin-1beta [IL-1ß] and matrix metalloproteinase-9 [MMP-9]) parameters around crestally and subcrestally placed dental implants 5 years after implant placement. MATERIALS AND METHODS: Fifty-two patients were divided into 2 groups: group 1 (n = 27): patients with single implants placed approximately 2 mm below the alveolar crest; group 2 (n = 25): patients with single implants placed at bone level. In both groups, peri-implant BOP, PPD, and CBL were measured, and levels of IL-1ß and MMP-9 were determined in duplicates using enzyme-linked immunosorbent assay. Full-mouth debridement was performed biannually in both groups. Statistical analysis was performed using the Mann-Whitney U test (significance set at p < 0.05). RESULTS: All measurements in groups 1 and 2 were performed 5.3 ± 0.2 and 5.2 ± 0.1 years after implant placement, respectively. The mean CBL was 1.2 ± 0.2 mm and 1.4 ± 0.2 mm in groups 1 and 2, respectively. There was no significant difference in mean BOP, PPD, CBL and in levels of IL-1ß, and MMP-9 among implants in both groups. CONCLUSION: Clinical, radiographic, and immunologic inflammatory parameters are comparable around crestally and subcrestally placed single dental implants up to 5 years after placement. The depth of implant placement appears to have no effect on clinical status and performance of single dental implants.

Intricate Evaluation of Association between Dental Caries and Obesity among the Children in Al-Kharj City (Saudi Arabia).

INTRODUCTION: Dental caries and obesity are two of the most prevalent health conditions affecting children. Relative decrease in corporeal movements, escalating inactive lifestyles, and changes in dietary factors are strongly linked with the increasing incidence of overweight and obesity. Furthermore, obesity increases the risk of chronic disease and dental caries that significantly affects the quality of life of young children. The present study intends to explore the relationship between dental caries and obesity in children in Al-Kharj city, Kingdom of Saudi Arabia. MATERIALS AND METHODS: The present descriptive study was designed as a cross-sectional study in which a total of 386 children in the age range of 6 to 12 years from elementary schools of Al-Kharj city and pediatric dental clinics in Prince Sattam Dental College were included. RESULTS: Mean decayed filled teeth (DFT) score was found to be considerably higher among obese children. Also, incidence of dental caries in deciduous dentition was found to be notably higher among obese children. CONCLUSION: Obesity has a considerable outcome on prevalence of dental caries among primary schoolchildren in Al-Kharj city, Kingdom of Saudi Arabia. The importance of obesity is limited not only to systemic disorders but also in relation to carious lesions. Hence, educating primary schoolchildren about caries and its related factors is very important. CLINICAL SIGNIFICANCE: High intake of free sugar is a well-established risk factor for dental caries and also for obesity. Therefore, it is speculated that factors that decrease these risk factors have the potential to affect both conditions at the population level to control it competently.