Osteoradionecrosis of the jaws: case series treated with adjuvant low-level laser therapy and antimicrobial photodynamic therapy

Abstract Background: Osteoradionecrosis of the jaw (ORNJ) is the most severe and complex sequel of head and neck radiotherapy (RT) because of the bone involved, it may cause pain, paresthesia, foul odor, fistulae with suppuration, need for extra oral communication and pathological fracture. We treated twenty lesions of ORNJ using low-level laser therapy (LLLT) and antimicrobial photodynamic therapy (aPDT). The objective of this study was to stimulate the affected area to homeostasis and to promote the healing of the oral mucosa. Methods: We performed aPDT on the exposed bone, while LLLT was performed around the bone exposure (red spectrum) and on the affected jaw (infrared spectrum). Monitoring and clinical intervention occurred weekly or biweekly for 2 years. Results: 100% of the sample presented clinical improvement, and 80% presented complete covering of the bone exposure by intact oral mucosa. Conclusion: LLLT and aPDT showed positive results as an adjuvant therapy to treat ORNJ.

Terapia fotodinámica como adyuvante en el tratamiento periodontal no quirúrgico: evaluación clínica / Photodynamic therapy as an adjuvant in nonsurgical periodontal treatment:A clinical evaluation

La terapia fotodinámica es considerada como un procedimiento no invasivo dentro de la práctica periodontal, reduciendo la morbilidad e incrementando la comodidad del paciente. Objetivo: el objetivo del presente estudio fue evaluar la eficacia clínica del uso de terapia fotodinámica como adyuvante al raspado y alisado radicular en periodontitis crónica. Material y métodos: se realizó un estudio comparativo, correlacional, aplicado a 20 pacientes con periodontitis crónica moderada-avanzada (pérdida de inserción clínica >- 6 mm) durante el raspado y alisado radicular no quirúrgico, con la adición de azul de metileno, donde se administró la terapia fotodinámica en dos sesiones, evaluando los parámetros clínicos (profundidad de bolsa, nivel de inserción clínico, índice de placa, sangrado al sondeo y recesión gingival). Resultados: tras cuatro semanas de evaluación postratamiento, no se observaron diferencias significativas en los parámetros clínicos entre el grupo experimental y control, aunque se encontró un mayor aumento de recesión gingival con el uso de la terapia fotodinámica (p=0,353). Conclusión: el uso de la terapia fotodinámica como adyuvante durante el raspado y alisado radicular convencional no proporciona beneficios adicionales al tratamiento periodontal convencional.

Photodynamic therapy is considered a non-invasiveprocedure in periodontal practice, one which reduces morbidity andincreases patient comfort. Objective: The aim of this study was toevaluate the clinical effi cacy of photodynamic therapy as an adjuvantto scaling and root planing in chronic periodontitis. Material andmethods: A comparative and correlational study was carried out on 20patients with moderate to advanced chronic periodontitis (attachmentloss ≥ 6 mm) during nonsurgical scaling and root planing, including theaddition of methylene blue. The photodynamic therapy was applied intwo sessions, during which the clinical parameters (pocket depth, clinicalattachment level, plaque index, bleeding on probing, and gingivalrecession) were assessed. Results: After four weeks of post-treatmentassessment, no signifi cant diff erences were found between the clinicalparameters of the experimental and control groups, although a greaterincrease in gingival recession was found when photodynamic therapywas used (p = 0.353). Conclusion: The use of photodynamic therapyas an adjuvant in conventional scaling and root planing provides noadditional benefi ts to conventional periodontal treatmen.

Long-term recurrence of nonmelanoma skin cancer after topical methylaminolevulinate photodynamic therapy in a dermato-oncology department

Abstract: BACKGROUND: Most available studies on the efficacy of topical photodynamic therapy focus on short-to medium-term results. Long-term data are scarce. OBJECTIVE: To evaluate the long-term efficacy of photodynamic therapy with topical methylaminolevulinate to treat Bowen's disease and basal cell carcinoma in the clinical practice setting of a dermato-oncology department. METHODS: The study included patients diagnosed with Bowen's disease or basal cell carcinoma, and who received photodynamic therapy from 2004 to 2008. Treatment protocol and clinical follow-up were standardized. The primary endpoint was clinically observed recurrence in a previous photodynamic therapy-treated area. Descriptive and survival analyses were performed. RESULTS: A total of 31 Bowen's disease lesions and 44 superficial basal cell carcinoma were treated, with a median follow-up of 43.5 months. Recurrence was observed in 14 Bowen's disease lesions (53.8%) and in 11 superficial basal cell carcinoma (33.3%). Significantly higher estimates for recurrence rates were found in patients with Bowen's disease (p=0.0036) or those aged under 58 years (p=0.039). The risk of recurrence was higher in patients with Bowen's disease than in those with superficial basal cell carcinoma and younger patients. CONCLUSIONS: Recurrence should be considered when choosing to treat non-melanoma skin cancer with photodynamic therapy. Younger age and Bowen's disease were independent predictors for long-term recurrence, suggesting the need to establish an extended period of follow-up for this subset of patients.

The association of fractional CO2 laser 10.600nm and photodynamic therapy in the treatment of onychomycosis

AbstractBACKGROUND:Onychomycosis is a fungal infection of the nails caused in most cases by dermatophytes Trichophyton rubrum and Trichophyton mentagrophytes. Despite numerous available antifungal drugs for therapy of this infection, the cure rate is low, with high rates of relapse after treatment and side effects.OBJECTIVES:To present a new option for the treatment of onychomycosis, in search of a more effective and rapid method than conventional ones.METHODS:Patients underwent two sessions of CO2 fractional laser 10.600nm associated with photodynamic therapy. Mycological and digital photography were performed before and after the treatment.RESULTS:McNemar test with continuity correction and degrees of freedom = 1: for clinical cure rate, 13.06, with p=0.00005; for mycological cure, 17.05, with p=0.00005; 72% felt fully satisfied with the procedure.CONCLUSIONS:The use of fractional CO2 laser 10.600nm associated with photodynamic therapy can be effective in the treatment of onychomycosis, decreasing the risk of systemic lesions that may be triggered with prolonged use of oral antifungals.

Conscious sedation with inhaled 50% nitrous oxide/oxygen premix in photodynamic therapy sessions for vulvar lichen sclerosus treatment

Photodynamic therapy has been described as an effective therapeutic option in selected cases of anogenital lichen sclerosus that are refractory to first-line treatments. However, procedure-related pain is a limiting factor in patient adherence to treatment. The authors report the case of a 75-year-old woman with highly symptomatic vulvar lichen sclerosus, successfully treated with photodynamic therapy. An inhaled 50% nitrous oxide/oxygen premix was administered during sessions, producing a pain-relieving, anxiolytic, and sedative effect without loss of consciousness. This ready-to-use gas mixture may be a well-tolerated and accepted alternative to classical anesthetics in Photodynamic therapy, facilitating patients' adherence to illumination of pain-prone areas.

Terapia fotodinâmica no tratamento periodontal: comparação microbiológica entre dois métodos / Photodynamic therapy adjunct in the treatment periodontal: microbiological comparison between two methods

a terapia fotodinâmica (PDT) tem a finalidade de reduzir os periodontopatógenos no biofilme dental através da associação de um laser a um corante fotossensibilizador, que culmina na produção de oxigênio singleto, levando à morte celular. Este estudo-piloto compara dois diferentes métodos de irradiação do laser de baixa potência na PDT, através da análise dos patógenos periodontais Porphyromonas gingivalis (P.g.), Tannerella forsythia (T.f.), Treponema denticola (T.d.) e Aggregatibacter actinomycetencomitans (A.a.). Material e métodos: este estudo-piloto é parte de um estudo clínico longitudinal, prospectivo, randomizado e duplo-cego. Foram selecionados cinco pacientes portadores de periodontite crônica, com dois dentes unirradiculares contralaterais com profundidade de sondagem maior ou igual a 5 mm, sem comprometimento sistêmico. Os pacientes foram submetidos à raspagem e alisamento radicular, e subsequentemente à PDT nos dentes experimentais. Estes foram alocados em dois grupos, de acordo com a maneira de entrega do laser: grupo A (transgengival) e grupo B (intrasulcular). A quantificação dos periodontopatógenos foi avaliada pela PCR em tempo real, sete e 30 dias após a intervenção, sendo adotado o nível de significância p ≤ 0,05. Resultados: não houve diferença entre os grupos A (irradiação transgengival) e B (irradiação intrasulcular), em relação aos níveis de A.a., T.f. e T.d. em qualquer momento do estudo. Em relação aos níveis de Pg, houve diferença significativa entre os grupos após 30 dias (p=0,032). Conclusão: os dois métodos foram semelhantes na redução de A.a., T.d. e T.f.. O método B (intrasulcular) mostrou uma redução significativa do patógeno P.g. no sétimo e 30º dia de avaliação.

Introduction: photodynamic therapy (PDT) has the purpose of reducing the periodontal biofilm by combining a laser with a photosensitizing dye that culminates in the production of singlet oxygen, leading to cell death. This pilot study compares two different methods of irradiation of low power laser in PDT, by analyzing the periodontal pathogen Porphyromonas gingivalis (P.g.), Tannerella forsythia (T.f.), Treponema denticola (T.d.) and actinomycetencomitans Aggregatibacter (A.a.). Material and methods: this pilot is part of a longitudinal, prospective, randomized, double-blind study. Were selected five patients with chronic periodontitis with two contralateral single-rooted teeth with depth greater than or equal to 5 mm, without systemic involvement. Patients underwent scaling and root planing and subsequent to PDT in experimental teeth, which were divided into two groups according to the manner of delivery of the laser: group A (transgingival) and group B (intrasulcular). The reduction of periodontal pathogens was evaluated by PCR real-time, 7 and 30 days after the intervention, with significance level p ≤ 0.05. Results: there was no difference between groups A (transgingival irradiation) and B (intrasulcular irradiation) with respect to A.a., T.f. and T.d. at any time during the study. With respect to levels of P.g., a significant difference between groups at 30 days (p=0.032). Conclusions: the two methods were similar in reducing A.a., T.d., T.f.. The method B (intrasulcular) showed a significant reduction in pathogen P.g. 7 and 30 days of evaluation.

Avaliação de mediadores inflamatórios após a terapia fotodinâmica no tratamento de bolsas periodontais residuais de pacientes em manutenção periodontal / Evaluation of inflammatory mediators following photodynamic therapy in the treatment of residual periodontal pockets of periodontal patients in maintenance

O objetivo deste estudo foi avaliar o impacto da terapia fotodinâmica (PDT) no tratamento de bolsas residuais de pacientes portadores de periodontite crônica em manutenção periodontal, através da avaliação de parâmetros imunológicos, durante 12 meses de acompanhamento. Foi conduzido um estudo prospectivo intervencional com 28 pacientes com periodontite crônica, que foram submetidos ao tratamento periodontal não-cirúrgico e apresentaram ao menos quatro sítios com bolsas residuais para serem submetidos à PDT. Os pacientes foram pareados em gênero, idade e média de profundidade clínica de sondagem (PCS) dos sítios experimentais, e assim sorteados em grupo teste (PDT) ou grupo controle. A intervenção foi feita no início do estudo, aos três, seis e nove meses e a coleta do fluido gengival foi realizada antes da intervenção, uma semana após, três e 12 meses depois. A avaliação imunólogica, realizada por meio do Luminex, quantificou os níveis de dez citocinas: interleucina (IL) IL-1(alfa), IL-1ß, IL-8, IL-1ra, fator de crescimento de fibroblastos (FGF), fator de crescimento vascular endotelial (VEGF), interferon- ? (IFN- Y), fator de necrose tumoral- (alfa) (TNF-(alfa)), IL-4 e IL-10. Em relação a essa análise, verificou-se que para o FGF, IL-4 e TNF-(alfa) não houve diferença estatística entre os grupos (p>0,05) em qualquer momento do estudo. Os mediadores IL-1(alfa), IL-1ß, IL-8 e VEGF apresentaram diferença significativa (p<0,05) entre os grupos, ao passo que os mediadores IL-1ra e IFN-Y demonstraram diferença estatística (p<0,01) ao longo do tempo em ambos os grupos e a IL-10 apresentou diferença estatística (p<0,01) aos 03 meses para o grupo PDT. Dentro dos parâmetros apresentados, a PDT se mostrou superior na modulação da inflamação.

The objective of this study was to evaluate the impact of photodynamic therapy (PDT) in the treatment of residual pockets of patients with chronic periodontitis in periodontal maintenance, by evaluating immunological parameters during 12 months of follow up. . An interventional prospective study in 28 patients with chronic periodontitis, who underwent non-surgical periodontal treatment and had at least four sites with residual pockets to undergo PDT was conducted. Patients were matched for gender, age and average probing pocket depth (PPD) of the experimental sites, and so drawn in group test (PDT) or control group. The intervention was done at baseline, at three, six, nine and gingival fluid collection was performed before intervention, a week after three and 12 months later. Immunological evaluation performed by the Luminex quantified levels ten cytokines: interleukin (IL) IL-1(alfa), IL-ß, IL-8, IL-1ra, fibroblast growth factor (FGF), vascular growth factor endothelial (VEGF), interferon-Y (IFN-Y), Tumor necrosis factor (alfa) (TNF-(alfa)), IL-4 and IL-10. In relation to this analysis, it was found that FGF, IL-4 and TNF-(alfa) was not different between groups (p> 0.05) at any time of the study. The mediators IL-(alfa), IL-1ß, IL-8 and VEGF showed a significant difference (p <0.05) between the groups, whereas IL-1ra mediators and IFN-Y showed a statistical difference (p <0.01) over time in both groups and IL-10 showed statistically significant difference (p <0.01) at 03 months for PDT group. Within the given parameters, the PDT was superior in the modulation of inflammation

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/cm 2 , 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.

Terapêutica fotodinâmica com ácido delta-aminolevulínico e luz de diodos em ceratoses actínicas / Photodynamic therapy with delta-aminolevulinic acid and light-emitting diodes in actinic keratosis

FUNDAMENTOS: A terapêutica fotodinâmica é técnica de tratamento em que se aplica uma substância fotossensibilizante nos tecidos ativada por uma fonte de luz de comprimento de onda específico, gerando destruição celular seletiva. Estudam-se novas fontes de luz que possam ser usadas no tratamento de ceratoses actínicas. OBJETIVOS: Avaliar a efetividade da terapêutica fotodinâmica com ácido delta-aminolevulínico utilizando como fonte de luz um aparelho emissor de luz de diodos no tratamento de ceratoses actínicas de face e membros superiores. MÉTODOS: Dezoito pacientes com ceratoses actínicas na face ou membros superiores realizaram uma aplicação de creme de ácido delta-aminolevulínico a 20 por cento e foram submetidos à exposição de luz de diodos, comprimento de onda de 630 nm. RESULTADOS: Foram tratadas 328 ceratoses actínicas, obtendo-se cura clínica completa em 210 (64,0 por cento) após 24 semanas. Lesões do dorso das mãos apresentaram cura clínica completa em 49,2 por cento; nas demais áreas esse valor foi de 81,4 por cento. Não houve registro de efeitos adversos graves, e obteve-se bom grau de satisfação dos pacientes com os resultados. CONCLUSÃO: A terapêutica fotodinâmica com fonte de emissão de luz de diodos mostrou-se eficaz e bem tolerada para tratamento de ceratoses actínicas, com resultados semelhantes aos encontrados na literatura utilizando outras fontes luminosas.

BACKGROUND: Photodynamic therapy is a form of treatment in which a photosensitizing substance is applied to tissue and activated by a light source at a specific wavelength, thus selectively destroying cells. New light sources are being evaluated for use in the treatment of actinic keratoses. OBJECTIVES: To evaluate the efficacy of photodynamic therapy with delta-aminolevulinic acid using a light emitting diode device as a light source in the treatment of actinic keratoses of the face and upper limbs. METHODS: Eighteen patients with actinic keratoses of the face or upper limbs received an application of a 20 percent delta-aminolevulinic acid cream and were submitted to diode light irradiation at a wavelength of 630 nm. RESULTS: A total of 328 actinic keratoses were treated, obtaining complete cure in 210 (64.0 percent) after 24 weeks. Lesions situated on the back of the hands were clinically cured in 49.2 percent of cases compared to 81.4 percent in the cases of lesions in other areas. There was no record of any severe adverse effects and patient satisfaction with the results was high. CONCLUSION: Photodynamic therapy with a diode light emitting source proved effective and well-tolerated for the treatment of actinic keratoses, with results similar to those reported in the literature with other light sources.

Nuevo tratamiento de la coriorretinopatía central serosa mediante terapia fotodinámica con verteporfino / New treatment of central serous chorioretinopathy (CSC) using photodynamic therapy (PDT) with verteporfin

Objetivo: Determinar si la Terapia Fotodinámica con verteporfino (TFD), es efectiva en los pacientes con Coriorretinopatía Serosa Central (CSC), y conocer su potencial papel como opción terapéutica. Método: Se realizó un estudio intervencional, prospectivo y no randomizado en 8 pacientes sintomáticos con CSC crónica o persistente documentada mediante Angiografía con fluoresceína (AGF), Angiografía con Verde Indocianina (ICG-A) y Tomografía de Coherencia Óptica (OCT), con afectación foveal. Todos los ojos recibieron de 1 a 3 sesiones de TFD. Se realizaron uno o más spots en la zona de hiperpermeabilidad vascular coroidea correspondiente al área de descompensación del Epitelio Pigmentario de la Retina (EPR), guiados mediante los resultados de ICG-A. Resultados: Ocho ojos de ocho pacientes con un seguimiento de 12 meses fueron evaluados. Se observó una disminución del calibre de los vasos coroideos y un descenso en el escape de fluoresceína en todos los pacientes (100 por ciento) tratados, a los 3 meses del tratamiento. Siete de los ocho pacientes (87,5 por ciento), experimentaron una mejoría de agudeza visual. No se observaron complicaciones sistémicas ni locales. Conclusiones: La TFD, guiada mediante ICG-A, parece ser un método efectivo en el tratamiento de la CSC: al cesar la fuga de fluoresceína a nivel foveal, que podría mejorar el pronóstico visual de los pacientes. No obstante son necesarios nuevos trabajos, randomizados, con series más largas y de mayor tiempo de seguimiento, para verificar la eficacia y la ausencia de complicaciones a largo plazo.