Transgingival photodynamic therapy (tg-aPDT) adjunctive to subgingival mechanical instrumentation in supportive periodontal therapy. A randomized controlled clinical study.

BACKGROUND: Recent data from preclinical studies and case series suggest that transgingival irradiation with diode lasers may represent a novel modality for antimicrobial photodynamic therapy (aPDT). However, at present, there is lack of data from controlled clinical studies on the use of transgingival antimicrobial photodynamic therapy (tg-aPDT) in the treatment of periodontitis. OBJECTIVE: To evaluate the clinical effects of tg-aPDT used in conjunction with nonsurgical mechanical instrumentation during supportive periodontal therapy (SPT). MATERIALS AND METHODS: Forty stage II and III periodontitis patients enrolled in SPT were randomly assigned to two groups of equal size. At baseline, study sites had to show sites with pocket probing depth (PPD) of ≥ 5 mm and Bleeding on Probing (BOP). Full mouth and site-specific Plaque-Index scores (PI), BOP, PPD, and Clinical Attachment Level (CAL) were recorded at baseline (BL), three months (3 M), and 6 months (6 M), respectively. The primary outcome variable was the change in the number of sites with BOP. Treatment was performed under local anaesthesia after random allocation to one of the following groups 1) Subgingival scaling and root planing (SRP) + tg-aPDT (test) or 2) SRP alone (control). RESULTS: Thirty-nine patients completed the study. Full mouth PI and BOP improved over six month, however without statistically significant difference between the groups. At 6 M, BOP-levels were statistically significantly lower in test sites (25.0 %) compared to the control sites (65.0 %), (p < 0.025). PPD improved in both groups with comparable mean values at 3 M (PPD test: 5.21 ± 0.92 mm; PPD control: 4.45 ± 1.36 mm) and 6 M (PPD test: 5.11 ± 1.10 mm; PPD control: 4.35 ± 1.14 mm). Additionally, CAL slightly improved in both groups with comparable mean values at 3 M (CAL test: 6.79 ± 1.72 mm; CAL control: 5.30 ± 2.43 mm) and 6 M (CAL test: 6.26 ± 1.70 mm; CAL control: 5.50 ± 2.33 mm). CONCLUSIONS: Within its limits, the present results appear to indicate that the use of tg-aPDT adjunctive to SRP may represent a new modality for controlling inflammation and further bleeding in residual periodontal pockets.

Anti-infective therapy of peri-implantitis with adjunctive local drug delivery or photodynamic therapy: 12-month outcomes of a randomized controlled clinical trial.

OBJECTIVE: The objective of the study is to compare the clinical, microbiological and host-derived effects in the non-surgical treatment of initial peri-implantitis with either adjunctive local drug delivery (LDD) or adjunctive photodynamic therapy (PDT) after 12 months. MATERIALS AND METHODS: Forty subjects with initial peri-implantitis, that is, pocket probing depths (PPD) 4-6 mm with bleeding on probing (BoP) and radiographic bone loss ≤2 mm, were randomly assigned to two treatment groups. All implants were mechanically debrided with titanium curettes and with a glycine-based powder airpolishing system. Implants in the test group (N = 20) received adjunctive PDT, whereas minocycline microspheres were locally delivered into the peri-implant pockets of control implants (N = 20). At sites with residual BoP, treatment was repeated after 3, 6, 9 and 12 months. The primary outcome variable was the change in the number of peri-implant sites with BoP. Secondary outcome variables included changes in PPD, clinical attachment level (CAL), mucosal recession (REC) and in bacterial counts and crevicular fluid (CF) levels of host-derived biomarkers. RESULTS: After 12 months, the number of BoP-positive sites decreased statistically significantly (P < 0.05) from baseline in both groups (PDT: 4.03 ± 1.66-1.74 ± 1.37, LDD: 4.41 ± 1.47-1.55 ± 1.26). A statistically significant (P < 0.05) decrease in PPD from baseline was observed at PDT-treated sites up to 9 months (4.19 ± 0.55 mm to 3.89 ± 0.68 mm) and up to 12 months at LDD-treated sites (4.39 ± 0.77 mm to 3.83 ± 0.85 mm). Counts of Porphyromonas gingivalis and Tannerella forsythia decreased statistically significantly (P < 0.05) from baseline to 6 months in the PDT and to 12 months in the LDD group, respectively. CF levels of IL-1ß decreased statistically significantly (P < 0.05) from baseline to 12 months in both groups. No statistically significant differences (P > 0.05) were observed between groups after 12 months with respect to clinical, microbiological and host-derived parameters. CONCLUSIONS: Non-surgical mechanical debridement with adjunctive PDT was equally effective in the reduction of mucosal inflammation as with adjunctive delivery of minocycline microspheres up to 12 months. Adjunctive PDT may represent an alternative approach to LDD in the non-surgical treatment of initial peri-implantitis.

Anti-infective therapy of peri-implantitis with adjunctive local drug delivery or photodynamic therapy: six-month outcomes of a prospective randomized clinical trial.

OBJECTIVE: To compare the adjunctive clinical effects in the non-surgical treatment of peri-implantitis with either local drug delivery (LDD) or photodynamic therapy (PDT). MATERIAL AND METHODS: Forty subjects with initial peri-implantitis, i.e. pocket probing depths (PPD) 4-6 mm with concomitant bleeding on probing (BoP) and marginal bone loss ranging from 0.5 to 2 mm between delivery of the reconstruction and pre-screening appointment were randomly assigned to two treatment groups. All implants underwent mechanical debridement with titanium curettes, followed by a glycine-based powder airpolishing. Implants in the test group (n = 20) received adjunctive PDT, whereas minocycline microspheres were locally delivered into the peri-implant pockets of control implants (n = 20). At sites with residual BoP, treatment was repeated after 3 and 6 months. The primary outcome variable was the change in the number of sites with BoP. Secondary outcome variables were changes in PPD, in clinical attachment level (CAL), and in mucosal recession (REC). RESULTS: After 3 months, implants of both groups yielded a statistically significant reduction (P < 0.0001) in the number of BoP-positive sites compared with baseline (LDD: from 4.41 ± 1.47 to 2.20 ± 1.28, PDT: from 4.03 ± 1.66 to 2.26 ± 1.28). After 6 months, complete resolution of mucosal inflammation was obtained in 15% of the implants in the control group and in 30% of the implants in the test group (P = 0.16). After 3 months, changes in PPD, REC, and modified Plaque Index (mPlI) were statistically significantly different from baseline (P < 0.05). No statistically significant changes (P > 0.05) occurred between 3 and 6 months. CAL measurements did not yield statistically significant changes (P > 0.05) in both groups during the 6-month observation time. Between-group comparisons revealed no statistically significant differences (P > 0.05) at baseline, 3 and 6 months with the exception of the mPlI after 6 months. CONCLUSIONS: In cases of initial peri-implantitis, non-surgical mechanical debridement with adjunctive use of PDT is equally effective in the reduction of mucosal inflammation as with the adjunctive use of minocycline microspheres up to 6 months. Adjunctive PDT may represent an alternative treatment modality in the non-surgical management of initial peri-implantitis. Complete resolution of inflammation, however, was not routinely achieved with either of the adjunctive therapies.