Photodynamic therapy during supportive periodontal care: clinical, microbiologic, immunoinflammatory, and patient-centered performance in a split-mouth randomized clinical trial.

BACKGROUND: This study investigates the effect of photodynamic therapy (PDT) as monotherapy during supportive periodontal therapy. METHODS: A split-mouth, randomized controlled trial was conducted in patients with chronic periodontitis (N = 22) presenting at least three residual pockets (probing depth [PD] ≥5 mm with bleeding on probing [BOP]). The selected sites randomly received the following: 1) PDT; 2) photosensitizer (PS); or 3) scaling and root planing (SRP). At baseline and 3 and 6 months, clinical, microbiologic (real-time polymerase chain reaction analyses), cytokine pattern (multiplexed bead immunoassay), and patient-centered (regarding morbidity) evaluations were performed. RESULTS: All therapies promoted similar improvements in clinical parameters throughout the study (P <0.05), except that BOP was not reduced in the PS protocol (P >0.05). Lower levels of Aggregatibacter actinomycetemcomitans were observed in the PDT and SRP protocols at 3 months when compared with the PS protocol (P <0.05). An inferior frequency detection of Porphyromonas gingivalis was observed in the PDT protocol at 3 and 6 months and in the SRP protocol at 6 months from baseline (P <0.05). In addition, PDT protocol presented inferior frequency of P. gingivalis at 3 months when compared with the other therapies (P <0.05). Only patients in the PDT protocol exhibited augmented levels of anti-inflammatory interleukin (IL)-4 and reduced proinflammatory IL-1ß and IL-6 throughout the study (P <0.05). Intergroup analyses showed reduced IL-10 and increased interferon-γ and IL-1ß levels in the PS protocol when compared with the other therapies during follow-ups (P <0.05). No differences in morbidity were observed between the therapies (P >0.05), although the need for anesthesia was higher in SRP-treated sites (P <0.05). CONCLUSION: PDT as an exclusive therapy may be considered a non-invasive alternative for treating residual pockets, offering advantages in the modulation of cytokines.

Photodynamic therapy in the treatment of class II furcation: a randomized controlled clinical trial.

AIM: To investigate the effect of photodynamic therapy (PDT) as adjunct to mechanical therapy in furcations. MATERIALS AND METHODS: A double-blind, parallel, randomized controlled clinical trial was conducted in subjects presenting class II furcations. The subjects were randomly allocated to a test (PDT; n = 16) or control group (non-activated laser/only photosensitizer; n = 21). At baseline, 3 and 6 months, clinical, microbiological and cytokine pattern evaluation was performed. Clinical attachment level was defined as the primary outcome variable. RESULTS: Clinical parameters improved after both therapies (p < 0.05) with no differences between groups at any time point (p > 0.05). At 6 months, real-time PCR evaluation showed a decrease in Porphyromonas gingivalis and Tannerella forsythia only in the PDT group (p < 0.05) with no inter-group differences. Regarding cytokines, IL-4 and IL-10 levels increased in both groups at 6 months. GM-CSF, IL-8, IL-1ß and IL-6 levels decreased only in the PDT group after 3 months (p < 0.05). At 3 months, inter-group analyses showed that GM-CSF, IFN-γ, IL-6 and IL-8 levels were lower in the PDT group. At 6 months, lower IL-1ß levels were also observed in the PDT group (p < 0.05). CONCLUSION: Photodynamic therapy did not promote clinical benefits for class II furcations; however, advantages in local levels of cytokines and a reduction in periodontopathogens were demonstrated.

Terapia fotodinâmica no tratamento da doença periodontal e peri-implantar / Photodynamic therapy in the treatment of periodontal disease and peri-implant disease

O tratamento periodontal consiste na remoção das bactérias periodontopatogênicas, por meio de raspagem e alisamento radicular (RAR), cujos resultados são bastante satisfatórios. Contudo, determinados sítios periodontais e peri-implantares podem não responder bem à terapia não cirúrgica, ocasionando a permanência de bolsas residuais. Dessa forma, alternativas vêm sendo propostas como adjuvantes à terapia mecânica, como o uso de antimicrobianos locais e sistêmicos, o uso de laser isolado e associado a um corante fotossensibilizador, processo conhecido como terapia fotodinâmica ou PDT (photodynamic therapy). Vários estudos têm mostrado que essa nova terapia parece ser uma abordagem terapêutica original e interessante, podendo ser um tratamento alternativo tanto na terapia da periodontite quanto da peri-implantite, apresentando reduzida morbidade e mínimo desconforto trans e pós-operatório. Contudo, é necessária maior quantidade de investigações clínicas controladas e randomizadas, a fim de comprovar a eficácia da terapia fotodinâmica como adjuvante ou como único tratamento para a resolução de doenças periodontais e peri-implantares.