Clinical and immunological peri-implant parameters among cigarette and electronic smoking patients treated with photochemotherapy: A randomized controlled clinical trial.

BACKGROUND: Although studies have been done that evaluated the effect of photodynamic therapy (PDT) in cigarette smokers and vapers, however, literature on the impact of these types of smoking on peri-implant parameters lack. The present clinical trial assessed the effectiveness of PDT as an adjunctive therapeutic modality in the treatment of peri-implant mucositis (p-iM) in individuals vaping e-cigs and cigarette smokers. METHODS: Individuals with p-iM were divided into three groups. (a) Group 1: Cigarette smokers with p-iM (b) Group 2: Vapers (e-cigarette smokers) with p-iM, (c) Group 3: Non-smokers with p-iM. Plaque index (PI), bleeding on probing (BOP) and probing depth (PD) were calculated. Pro-inflammatory biomarkers including matrix metalloproteinase (MMP)-8 and tumor necrosis factor-alpha (TNF-α) were quantified using enzyme linked immunosorbent assay. All assessments were performed at baseline (before treatment) and 12 weeks post treatment. Full mouth disinfection (FMD) was done with the ultrasonic scaler and copious irrigation. The photodynamic therapy (PDT) was done with a diode laser (wavelength: 670 nm, power: 150 mW, density: 1.1 W/cm2). Methylene blue photosensitizer (0.005% concentration) was incorporated inside the periimplant pockets (10 seconds at a depth of 3 mm), and the pockets were irradiated a flexible tip for one minute on the buccal and lingual surfaces. The session of PDT was performed only once at baseline. RESULTS: Twenty-five cigarette-smokers (Group 1), 21 electronic cigarette smokers (Group 2) and 25 never-smokers (Group 3) participated in the study. The mean age of the selected participants in groups 1, 2 and 3 was 29.5, 27.8, and 30.2 years, respectively. Statistically significant reduction in PI and PD parameters was observed on baseline and at 12 weeks in all groups. BOP significantly increased in group 1 and 2 at 12 weeks. A statistically significant reduction from baseline to 12 weeks was reported in the biomarker levels for all the study groups. CONCLUSION: PDT with adjunctive mechanical debridement reduced the plaque index and probing depth, while increased bleeding on probing, in addition to reducing pro-inflammatory biomarkers in tobacco smokers.

Clinical peri-implant health and biological bone marker levels in tobacco users treated with photodynamic therapy.

BACKGROUND: What impact does tobacco smoking have on photodynamic therapy (PDT) outcome is still unknown. The aim of the present clinical trial was to evaluate the clinical, radiographic, and biological bone markers after provision of PDT in cigarette, e-cigarette, and never-smokers with peri-implantitis (PI) at 6 months post treatment. MATERIALS AND METHODS: Twenty-five healthy patients with PI were divided into three groups: Group I: cigarette smokers; Group II: e-cigarettes users; Group III: never-smokers. Full-mouth mechanical debridement with adjunctive methylene blue-mediated PDT was performed. Clinical recordings included peri-implant plaque index (Pi), bleeding on probing (BOP) and probing depth (PD). Peri-implant sulcular fluid was collected for the assessment of biological bone biomarkers including receptor activator of nuclear factor-ligand (RANK-L) and osteoprotegrin (OPG). All assessments were performed at baseline, 3 months and 6 months. P-value of <0.05 was considered significant. RESULTS: BOP in Group II and III significantly reduced at 3 months (p < 0.05). Group I showed significant reduction only at 6 months (p < 0.05). Mean PD showed no statistically significant difference between the groups at any time-point. Inter-group comparison showed Group III demonstrating statistically significantly reduced mean RANK-L levels at both 3 and 6 months (p < 0.05). A slight increase in the OPG levels were observed at 3 months and followed by a slight decrease at 6 months for all the study groups when compared with baseline values, however, these values did not show statistical significance (p > 0.05). CONCLUSION: Adjunctive PDT helped in reducing the clinical peri-implant inflammation. However, no significant change was observed for biological bone biomarkers among tobacco smokers.