Clinical efficacy of photodynamic therapy as an adjunct to mechanical debridement in the treatment of per-implantitis with abscess

Adjunctive photochemical therapy for management of inflammatory peri-implant diseases: A systematic review and meta-analysis

This study aimed to systematically review the data on interventions involving adjunctive photochemical therapy in treating peri-implant mucositis (PIM) and peri-implantitis (PI). The electronic search was conducted through six databases in October 2023, seeking studies relying on any kind of adjunctive photochemical therapy in treating inflammatory peri-implant diseases (PIDs). To showcase the effect size, mean differences along with 95% confidence intervals were utilized. Forty-seven studies were deemed eligible for qualitative synthesis, 14 of which were included in the meta-analysis. Low-level light therapy and photodynamic therapy led to enhanced improvements in clinical and radiographic indices, such as bone level (BL), bleeding on probing (BoP), clinical attachment level (CAL), and probing depth (PD), during the 3-month follow-up. However, the differences in efficacy between treatments incorporating adjunctive photochemical therapy and those relying solely on mechanical debridement, considered the gold standard, lessened over extended follow-up periods of 6, 9, and 12 months. Significant differences were observed when comparing the treatment outcomes following adjunctive photochemical therapy between obese and smoker patients with healthy subjects. Incorporating adjunctive photochemical therapy for PID treatment might improve clinical and radiographic parameters in a short-term follow-up of 3 months, but longer-term benefits appear comparable to routine treatments.

Non-surgical management of peri-implantitis with photodynamic therapy: A systematic review and meta-analysis of clinical parameters and biomarkers

OBJECTIVE

To evaluate the clinical and biomarker outcomes of photodynamic therapy (PDT) as an adjunct to non-surgical mechanical debridement (MD) in the management of peri‑implantitis, and to compare its efficacy to MD alone or other non-surgical treatment modalities.

DATA AND SOURCES

Electronic searches in PubMed, Web of Science, and CENTRAL were conducted. 4675 studies published until November 2023 were screened. Clinical studies reporting on non-surgical treatments involving PDT were selected. Meta-analyses assessed clinical parameters (bleeding on probing [BOP], probing depth [PD], plaque index [PI], crestal bone loss [CBL], clinical attachment level [CAL]) and biomarkers.

STUDY SELECTION

A total of 25 studies were included. The meta-analysis of randomized controlled trials revealed that both MD alone and MD+PDT significantly improved clinical and biomarker outcomes compared to baseline. The addition of PDT provided greater improvements at 3 months for BOP (SMD:0.90; 95 % CI:1.53 to -0.28; p = 0.005), PD (SMD:1.15; 95 % CI:1.72 to -0.58; p < 0.0001), PI (SMD:0.74; 95 % CI:1.15 to -0.33; p = 0.0004) and CBL (SMD:0.38; 95 % CI:0.73 to -0.03; p = 0.04). The additional benefits of PDT were less pronounced on CAL, mucosal recession, and inflammatory biomarkers. No significant changes were observed over extended follow-up periods.

CONCLUSIONS

Adjunct PDT significantly enhanced clinical outcomes, particularly for the short-term, with the most notable benefits observed in BOP, PD, PI, and CBL reductions. However, additional benefits in CAL, mucosal recession, and inflammatory biomarkers outcomes remain limited. Standardized protocols and long-term studies are warranted.

CLINICAL SIGNIFICANCE

PDT as an adjunct in non-surgical peri-implantitis management improves short-term clinical outcomes, particularly for BOP, PD, PI, and CBL. The benefits of adjunctive use with mechanical debridement offer a promising and minimally invasive approach. Further long-term research is needed to establish its role in routine clinical practice.

Potential Impact of Microbial Variations After Peri-Implantitis Treatment on Peri-Implant Clinical, Radiographic, and Crevicular Parameters: A Systematic Review

Objectives: This systematic review evaluated concomitant trends in microbial (total biofilm load and pre-dominant pathogens' counts) and clinical, radiographic, and crevicular variations following (any) peri-implantitis treatment in partially vs. totally edentulous, systemically healthy, non-smoking adults and compared them to peri-implant mucositis treated sites. Methods: The study protocol, compliant with the PRISMA statement, was registered on PROSPERO (CRD42024514521). Findings from six randomized controlled trials (RCTs), evaluated through the ROBINS-2 tool, were qualitatively synthesized. Results: No data concerning total edentulism and treated peri-implant mucositis sites were retrieved from the included RCTs. Instead, as expected, in the partially edentulous subjects, peri-implantitis treatments effectively provided biofilm control, although Plaque Index (PI) tended to increase again over time. Notably, Bleeding on Probing (BoP) rose slightly after treatment but decreased markedly by three months, indicating, at least, a partial resolution of the infective-inflammatory process. Probing Depth (PD) showed a slower but consistent improvement throughout. Despite a return of PI levels by twelve months, BoP and PD continued to improve, underscoring the successful long-term outcomes of peri-implantitis treatment. Over time, variations in PI did not consistently reflect changes in predominant pathogenic species, especially at the 1-month follow-up; BoP aligned with predominant pathogens rather than total microbial biofilm load at the 1- and 3-month follow-ups, and PD did the same at the 3- and 6-month follow-ups, likely affecting peri-implantitis-associated microbiota. No data concerning crevicular parameters were retrieved in the included RCTs, and the extracted radiographic outcomes were not comparable. Conclusions: The impact of the microbial variations after peri-implantitis treatment on peri-implant clinical parameters highlight the critical role of dysbiosis, rather than total microbial load, in influencing inflammation and tissue destruction, emphasizing the need for targeted approaches to manage persistent pathogens and improve treatment efficacy.

Use of Lasers in the Nonsurgical Treatment of Peri-Implantitis: A Systematic Review of the Literature

Peri-implantitis is an infectious disease that causes inflammation of the tissue surrounding an implant. The aim of this systematic review of the literature is to assess the effect of the use of lasers in the nonsurgical treatment of peri-implantitis in order to estimate its benefits compared with conventional therapies. The review's protocol has been registered on PROSPERO international prospective register. The research strategy was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were as follows: in vivo studies, written in English, measurements of clinical parameters, minimum follow-up at 6 months and with nonsurgical control group, studies about photodynamic therapy, randomized clinical trial, and clinical trial. Electronic (on PubMed, Cochrane, Latin American and Caribbean Health Sciences Literature, and Report Evidence-based Practice Centers databases) and manual searches (in articles' references) were conducted until July 2021. Risk of bias was assessed for each reference thanks to the Cochrane Collaboration's tool. A total of 12 randomized clinical trials, with a high level of evidence, were selected and investigated in this systematic review. A table summarizes data extracted from these articles. It appears that the parameters improve favorably by using lasers, but without any significant difference. In accordance with the analysis of studies, our results show that laser therapy with specific characteristics allows to obtain beneficial therapeutic effects on wound healing in the short and the medium-term concerning the clinical parameters in the nonsurgical treatment of peri-implantitis. Concerning its long-term usefulness, it has yet to be confirmed. However, its benefits remains limited since the results agree that the effects of the laser are similar to those obtained by using conventional therapy.

Peri-Implantitis-Associated Microbiota before and after Peri-Implantitis Treatment, the Biofilm "Competitive Balancing" Effect: A Systematic Review of Randomized Controlled Trials

This systematic review of RCTs aimed to characterize short- and long-term changes in peri-implantitis-associated microbiota (total biofilm microbial load and predominant pathogens' counts) following (any) peri-implantitis treatment in systemically healthy, non-smoking, partially/totally edentulous adults. The study protocol, compliant with the PRISMA statement, was registered on PROSPERO (CRD42024514521) before the literature search. Data from 11 RCTs, assessed through the ROBINS-2 tool, were qualitatively synthesized. No data were retrieved on total edentulism, healthy peri-implant/periodontal sites, treated mucositis, gingivitis, and periodontitis sites. Shortly after treatment, Prevotella intermedia, Fusobacterium nucleatum, and Peptostreptococcus micros prevailed, indicating early colonization, as after implant placement. After both surgical and non-surgical approaches, although not eradicated, the peri-implant total biofilm load, red- and orange-complex species, and Aggregatibacter actinomycetemcomitans counts generally decreased for up to about three months. However, one month after treatment, red-complex species and Prevotella intermedia increased, likely due to persistent tissue-invasive bacteria, unresolved pathological conditions (high probing depth values) favoring anaerobiosis and dysbiosis, and a qualitatively and quantitatively decreased biofilm community, competing and balancing the predominant pathogens (biofilm "competitive balancing" effect), thus allowing recolonization by more virulent bacteria. Red-complex bacteria gradually leveled off to baseline at the six- and twelve-month follow-ups. Fusobacterium nucleatum remained almost unchanged after treatment.

Do systemic amoxicillin and metronidazole during the non-surgical peri-implantitis treatment phase prevent the need for future surgical treatment? A retrospective long-term cohort study

AIM

The aim of this retrospective long-term follow-up of a 3-month RCT was to assess whether non-surgical peri-implantitis treatment with adjunctive systemic antibiotics influenced the need for additional surgical treatment.

MATERIALS AND METHODS

Patients enrolled in an aftercare programme following non-surgical peri-implantitis treatment, with or without systemic amoxicillin and metronidazole, were analysed. Data had previously been collected pre-treatment (T0) and 3 months after treatment (T1) and were additionally collected during subsequent aftercare visits, until the final assessment (T2). Primary outcome was the need for additional surgical peri-implantitis therapy during the aftercare programme, analysed via Kaplan-Meier analysis and Cox regression. Secondary outcomes involved clinical parameters, assessed using parametric and non-parametric tests.

RESULTS

Forty-five patients (22 AB- group, 23 AB+ group) were included. The mean follow-up time between T1 and T2 was 35.9 months (SD = 21.0). 73.9% of the AB+ group and 50.0% of the AB- group did not receive additional surgical therapy (log-rank test, p = .110). The adjusted Cox regression model did not provide a significant result for antibiotics (β = .441, 95% CI = 0.159-1.220, p = .115). Univariable regression analysis highlighted the influence of baseline peri-implant pocket depth on the need for surgical treatment (β = 1.446, 95% CI = 1.035-2.020, p = .031).

CONCLUSIONS

Systemic amoxicillin and metronidazole administered during non-surgical peri-implantitis treatment do not seem to prevent the need for additional surgical therapy in the long term, during a structured aftercare programme.

Microbiota of Peri-Implant Healthy Tissues, Peri-Implant Mucositis, and Peri-Implantitis: A Comprehensive Review

Understanding the microbiological profiles of peri-implant conditions is crucial for developing effective preventive and therapeutic strategies. This narrative review analyzes the microbial profiles associated with healthy peri-implant sites, peri-implant mucositis, and peri-implantitis, along with related microbiological sampling and analyses. Healthy peri-implant sites are predominantly colonized by Streptococcus, Rothia, Neisseria, and Corynebacterium species, in addition to Gram-positive cocci and facultatively anaerobic rods, forming a stable community that prevents pathogenic colonization and maintains microbial balance. In contrast, peri-implant mucositis shows increased microbial diversity, including both health-associated and pathogenic bacteria such as red and orange complex bacteria, contributing to early tissue inflammation. Peri-implantitis is characterized by even greater microbial diversity and a complex pathogenic biofilm. Predominant pathogens include Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Fusobacterium nucleatum, and unique species like Filifactor alocis and Fretibacterium fastidiosum. Additionally, less common species such as Staphylococcus and Enterobacteriaceae, contributing to disease progression through biofilm formation and increased inflammatory response, along with EBV and human cytomegalovirus with a still not defined role, and Candida albicans contribute to disease progression through biofilm formation, immune modulation, and synergistic inter-kingdom interactions. Future research should standardize diagnostic criteria, employ advanced molecular techniques, integrate microbial data with clinical factors, and highlight inter-kingdom interactions.

Antimicrobial Activity of Methylene Blue Associated with Photodynamic Therapy: In Vitro Study in Multi-Species Oral Biofilm

The control of infectious diseases caused by biofilms is a continuing challenge for researchers due to the complexity of their microbial structures and therapeutic implications. Photodynamic therapy as an adjunctive anti-infective treatment has been described as a possible valid approach but has not been tested in polymicrobial biofilm models. This study evaluated the effect of photodynamic therapy in vitro with methylene blue (MB) 0.01% and red LEDs (λ = 660 nm, power density ≈ 330 mW/cm2, 2 mm distance from culture) on the metabolic activity and composition of a multispecies subgingival biofilm. Test Groups LED and MB + LED showed a more significant reduction in metabolic activity than the non-LED application group (~50 and 55%, respectively). Groups LED and MB equally affected (more than 80%) the total bacterial count in biofilms. No differences were noted in the bacterial biofilm composition between the groups. In vitro LED alone or the MB + LED combination reduced the metabolic activity of bacteria in polymicrobial biofilms and the total subgingival biofilm count.

Comparative effectiveness of interventions for the treatment of peri-implantitis: A systematic review with network meta-analysis

STATEMENT OF PROBLEM

Extensive research has been carried out on the various aspects of diagnosing and treating peri-implantitis. However, clinical guidelines for the management of peri-implantitis based on high quality evidence are lacking.

PURPOSE

The purpose of this systematic review with network meta-analysis was to analyze the current evidence on nonsurgical and surgical interventions for the treatment of peri-implantitis and synthesize clinical guidelines based on high quality evidence.

MATERIAL AND METHODS

A search was conducted for trials published in Medline, Scopus, PubMed, and Cochrane Central Register of Controlled Trials from inception until July 2023. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023451056). A network meta-analysis was performed on data from randomized controlled trials that assessed nonsurgical and surgical interventions for the treatment of peri-implantitis. The interventions were ranked according to their efficacy using surface under the cumulative ranking (SUCRA) system. The grading of recommendations, assessment, development, and evaluations (GRADE) approach was used to assess the level of certainty of evidence.

RESULTS

A total of 45 articles were included in the quantitative analysis. The GRADE approach determined a moderate to high level of certainty of evidence. Among the nonsurgical interventions, mechanical debridement with adjunctive systemic antibiotics was significant in improving probing depth at 3 months and beyond 6 months, clinical attachment loss at 3 months, and clinical attachment loss beyond 6 months. Mechanical debridement with adjunctive topical antibiotics was significant in improving probing depth beyond 6 months, clinical attachment loss at 3 months, clinical attachment loss beyond 6 months, and radiographic bone loss beyond 6 months. Mechanical debridement with adjunctive photodynamic therapy was significant in improving probing depth beyond 6 months, clinical attachment loss at 3 months, clinical attachment loss beyond 6 months, and radiographic bone loss beyond 6 months. Mechanical debridement with adjunctive systemic antibiotics and photodynamic therapy was significant in improving probing depth beyond 6 months. Among surgical interventions, open flap debridement with implant surface decontamination and open flap debridement with decontamination and adjunctive photodynamic therapy were significant in improving probing depth at 3 months.

CONCLUSIONS

Mechanical debridement with adjunctive systemic antibiotics or photodynamic therapy results in improved clinical outcomes.

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.

Antimicrobial photodynamic therapy for the management of gingivitis and white spot lesions in fixed orthodontic patients: A systematic review

AIM

We conducted this review to evaluate the safety and efficacy of antimicrobial photodynamic therapy (aPDT) for the management of gingivitis and white spot lesions (WSLs) in fixed orthodontic patients.

METHODS

The PubMed/MEDLINE, Cochrane Library, Scopus, and Google Scholar databases were searched for randomized controlled trials and clinical trials assessing the clinical effectiveness of aPDT for the management of gingivitis and WSLs in fixed orthodontic patients without time limitation. Primary outcomes were the changes in clinical parameters such as DIAGNOdent, plaque index (PI), bleeding on probing (BOP), and gingival index (GI). Secondary outcomes included measurements of microbial and inflammatory factors, such as cytokine levels (tumor necrosis factor alpha [TNF-α], interleukin-1 beta [IL-1β], and interleukin-6 [IL-6]), and bacterial counts.

RESULTS

Our search yielded a total of 12 studies that met the inclusion criteria. Among the 11 studies that evaluated gingivitis, the majority employed a diode laser (670nm, 150 mW, 22J/cm2, 60seconds) as the light source and methylene blue at a concentration of 0.0005% (applied for 3minutes) as the photosensitizer in a single treatment session. The included studies reported positive effects of aPDT on gingivitis management, with more improvements observed in PI, BOP, and GI following aPDT treatment. Additionally, aPDT was found to reduce the counts of periopathogens such as Porphyromonas gingivalis, as well as inflammatory factors (TNF-α, IL-1β, and IL-6). Two studies demonstrated that aPDT, particularly when administered in multiple sessions, effectively controlled the extent of WSLs during orthodontic treatment and yielded favorable outcomes that persisted for several months after treatment.

CONCLUSION

Based on the available evidence, aPDT appears to be a safe and effective treatment option for managing WSLs and gingivitis in patients with fixed orthodontic appliances. However, further high-quality RCTs are necessary to investigate the impact of potential confounding factors on the efficacy of aPDT.

Clinical and Radiographic Outcomes of Adjunctive Phototherapy Versus Antibiotic Therapy Against Peri-Implant Diseases: A Systematic Review and Meta-Analysis

Background: Peri-implantitis, an inflammatory condition in implant tissues, requires bacterial eradication and implant surface decontamination, with aPDT as a helpful surgical adjunct. Objective:This project was designed to investigate the effect of antibiotic therapy versus aPDT, as adjuncts to conventional mechanical debridement (MD), on the peri-implant clinical and/or radiographic parameters among patients with peri-implant diseases. Methods: A comprehensive search was conducted across electronic databases, including PubMed, Scopus, and Web of Science, up to and including April 2023, without any restriction on the language and year of publication, focusing the following research question: "Does adjunctive aPDT improve the peri-implant clinical and/or radiographic parameters in treating peri-implant diseases compared to antibiotic therapy?" Statistical analysis was performed on peri-implant clinical [plaque index (PI), probing depth (PD), and bleeding on probing (BOP)] and radiographic parameters [marginal bone loss (MBL)]. The study included six randomized controlled trials and one clinical (nonrandomized) study. Results: The systematic review findings indicate that the application of aPDT as an adjunct to MD is equally effective as adjunctive antibiotic therapy in improving peri-implant clinical parameters and radiographic parameters in patients with peri-implant diseases. Only two studies were classified as having a low risk of bias (RoB), two were assessed as having an unclear RoB, and the remaining three studies were determined to have a high RoB. However, the meta-analysis results revealed no statistically significant difference in peri-implant PI, PD, and MBL scores between patients treated with adjunct aPDT or adjunct antibiotic therapy. Notably, there was a statistically significant difference favoring adjunct aPDT in peri-implant BOP values compared to the control group. Conclusions: Despite the limited number of included studies and the significant heterogeneity among them, the findings suggest that aPDT yields comparable peri-implant clinical and radiographic outcomes to adjunctive antibiotic therapy, as adjuncts to MD, for the potential treatment of peri-implant diseases.

Etiology, pathogenesis and treatment of peri-implantitis: A European perspective

Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants. It is characterized by inflammation in the peri-implant mucosa and progressive loss of supporting bone. Over the last 30 years, peri-implantitis has become a major disease burden in dentistry. An understanding of the diagnosis, etiology and pathogenesis, epidemiology, and treatment of peri-implantitis must be a central component in undergraduate and postgraduate training programs in dentistry. In view of the strong role of European research in periodontology and implant dentistry, the focus of this review was to address peri-implantitis from a European perspective. One component of the work was to summarize new and reliable data on patients with dental implants to underpin the relevance of peri-implantitis from a population perspective. The nature of the peri-implantitis lesion was evaluated through results presented in preclinical models and evaluations of human biopsy material together with an appraisal of the microbiological characteristics. An overview of strategies and outcomes presented in clinical studies on nonsurgical and surgical treatment of peri-implantitis is discussed with a particular focus on end points of therapy and recommendations presented in the S3 level Clinical Practice Guideline for the prevention and treatment of peri-implant diseases.

Adhesive Bond Strength of Restorative Materials to Caries-Affected Dentin Treated with Antimicrobial Photodynamic Therapy: A Systematic Review and Meta-Analysis

Objective: This systematic review aimed to evaluate the adhesive bond strength of restorative materials to caries-affected dentin (CAD) treated with antimicrobial photodynamic therapy (aPDT) in comparison with conventional chemical disinfectants. Methods: Three databases, including the Web of Science, Scopus, and PubMed, were searched to address the focused question: "What is the effect of aPDT compared to conventional chemical disinfection techniques on the adhesive bond strength of restorative materials to CAD?." Search keywords included "dentin*" "adhes bond*" "caries-affected dentin" "photodynamic "photochemotherapy" "photosensitizing agent" "phototherapy" "photoradiation" "laser" "light activated" "photoactivated." A fixed-effects model was used in each meta-analysis and the inverse variance was used to calculate the standard mean difference (SMD). For evaluating the statistical heterogeneity, the Cochrane's Q test and the I2 statistics were used. The risk of bias was evaluated based on the Cochrane Collaboration's tool. Results: Fourteen studies were included in the qualitative as well as quantitative analysis. The results of the meta-analyses exhibited an SMD of 2.38% [95% confidence interval (CI): 2.03-2.73; p < 0.00001], indicating a statistically significant difference in the shear bond strength scores between the tested group (samples treated with aPDT) and the control group (i.e., favoring the sound dentin and/or conventional chemical disinfectants). Contrarily, an SMD of -1.46% (95% CI: -2.04 to -0.88; p < 0.00001) and -0.37% (95% CI: -0.70 to -0.03; p = 0.03) was observed, indicating a statistically significant difference in the microtensile bond strength (μTBS), as well as microleakage scores between the tested group (favoring the samples treated with aPDT) and the control group (i.e., sound dentin and/or conventional chemical disinfectants). Conclusions: Adhesive bond strength of restorative materials to CAD treated with conventional chemical disinfectants showed superior outcomes compared to photodynamic therapy (aPDT).

Antimicrobial photodynamic therapy for managing the peri-implant mucositis and peri-implantitis: A systematic review of randomized clinical trials

BACKGROUND

The presence of peri‑implant inflammation including peri‑implant mucositis and peri‑implantitis, is a crucial factor that impacts the long-term stability and success of dental implants. This review aimed to evaluate the safety and effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjuvant therapy option for managing peri‑implant mucositis and peri‑implantitis.

METHODS

We systematically searched the PubMed/MEDLINE, Cochrane Library, Scopus, and Google Scholar databases (no time limitation). The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the quality of the studies was assessed using the Cochrane Collaboration tool.

RESULTS

Of 322 eligible articles, 14 studies were included in this review. The heterogeneity and poor quality of the articles reviewed prevented a meta-analysis. The reviewed articles used a light source (60 s, 1 session) with a wavelength of 635 to 810 nm for optimal tissue penetration. These studies showed improved clinical parameters such as probing depth, bleeding on probing (BOP), and plaque index after aPDT treatment. However, in smokers, BOP increased after aPDT. Compared to conventional therapy, aPDT had a longer-term antimicrobial effect and reduced periopathogens like Porphyromonas gingivalis, as well as inflammatory factors such as Interleukin (IL)-1β, IL-6, and Tumor necrosis factor alpha (TNF-α). No undesired side effects were reported in the studies.

CONCLUSION

Although the reviewed articles had limitations, aPDT showed effectiveness in improving peri‑implant mucositis and peri‑implantitis. It is recommended as an adjunctive strategy for managing peri‑implant diseases, but further high-quality research is needed for efficacy and long-term outcomes.

The Efficacy of Ten Different Adjunctive Measures in Patients with Nonsurgically Treated Peri-Implant Disease: A Network Meta-Analysis of Randomized Controlled Trials

Objective: This study aimed to evaluate the impact of 10 adjunctive measures on non-surgical therapy outcomes for peri-implant disease. Methods: We formulated the study question and keywords following the Population, Intervention, Comparator, Outcome framework. Randomized controlled trials were identified through searches in PubMed, Embase, the Cochrane Library, and the Web of Science. Two researchers assessed the quality of included literature according to the Cochrane Risk of Bias Assessment Tool. Data analysis and ranking were performed using Stata 15.0 software. Results: This study, involving 51 pieces of literature and 2660 samples, conducted a network meta-analysis (NMA), which revealed that photodynamic therapy (PDT) significantly reduced probing pocket depth values in patients with peri-implant mucositis (SUCRA = 96.3%) and peri-implantitis (SUCRA = 96.7%). In addition, it showed an improvement in bleeding on probing (BOP) values for peri-implantitis (SUCRA = 91.6%). Furthermore, diode lasers improved BOP values for peri-implant mucositis (SUCRA = 76.5%). Conclusions: According to the NMA results and the surface under the cumulative ranking curve (SUCRA), PDT and diode laser outperform other adjuncts in peri-implant disease.

Conditioning of PEEK Implant Abutment Surfaces Using Photodynamic Therapy, Nd:YAG Laser, and Conventional Methods to Evaluate Shear Bond Strength

Objective: This study was done to evaluate shear bond strength (SBS) and modes of failures after different surface treatment modalities on polyetheretherketone (PEEK) implant abutments. Materials and methods: Seventy-five PEEK implant abutment specimens were randomly distributed into five groups based on surface treatment methods: Group I: No treatment, Group II: methylene blue-mediated photodynamic therapy (MB-PDT), Group III: neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, Group IV: Sulfuric acid (H2SO4), and Group V: Sandblasting (Sb). The measurements for SBS and failure modes for PEEK implant abutment specimens were evaluated via Universal Testing Machine and Stereomicroscope, respectively. Two-way analysis of variance and Tukey's post-hoc test (p > 0.05) were used for the statistical analysis. Moreover, the Shapiro-Wilk normality test was also performed for normality. Results: The SBS mean values and standard deviations in megapascals (MPa) for PEEK abutment specimens with different surface pretreatment groups are shown in Table 1 and Fig. 1. The control group had the lowest SBS (9.67 ± 2.1 MPa), while the highest SBS was observed in Group II (MB-PDT; 17.21 ± 1.32 MPa). SBS values for Group IV (H2SO4; 15.83 ± 0.63 MPa) and Group III (Nd:YAG laser; 16.91 ± 2.10 MPa) were similar to Group II (MB-PDT; p > 0.05). The SBS values for the sandblasted specimens (13.90 ± 1.87 MPa) were not significantly different from the control group (p > 0.05). Conclusions: The PEEK implant abutment surfaces treated with MB-PDT and Nd:YAG laser expressed significantly improved SBS.

Diagnosis and Treatment of Periimplant Mucositis and Periimplantitis: An Overview and Related Controversial Issues

Periimplant mucositis and periimplantitis are common complications of dental implant. This article provides a comprehensive overview of the 2017 World Workshop's new definition, clinical and radiographic presentation, pathogenesis, risk factors, and classification of periimplant diseases. Also, the authors discuss various types of instruments, materials, and techniques commonly used for treatment of nonsurgical and surgical periimplantitis. Lastly, the authors include some controversial topics surrounding this subject.

Clinical and radiographic peri-implant outcomes with riboflavin loaded Poly-L-glycolic acid nanoparticles incorporated in aloe-vera gel treating peri-implantitis in chronic hyperglycemic patients

AIM

The objective of the current study was to compare the effectiveness of antimicrobial photodynamic therapy (PDT) versus Poly-L-glycolic acid nanoparticles loaded riboflavin incorporated in aloe vera gel (PGA/RF/AV) on periimplant parameters and bacterial counts in chronic hyperglycemic patients having periimplantitis.

METHODS

One hundred and two diabetic patients undergoing mechanical debridement (MD) were equally divided into three groups: Group 1: PGA/RF/AV+ MD, Group 2: PDT + MD, and Group 3: MD alone. Periimplant parameters [Bleeding on probing (BoP), probing depth (PD), plaque index (PI), marginal bone level (MBL)] were recorded in all three groups. Periimplant plaque samples were studied to record the levels of Tannerella forsythia (Tf) and Porphyromonas gingivalis (Pg). The recordings were taken at baseline, 3 months and 6 months post treatment.

RESULTS

All three groups showed a reduction in severity of periimplantitis measured in terms of PD, PI, MBL and BoP. A statistically significant reduction in PD, PI and MBL was found in patients in Group 2 whereas participants of Group 1 were found to have a significant decrease in BoP. A statistically significant decline in the numbers of both the bacterial species was seen in Group 2 at the three-month follow-up whereas at the six-month follow-up, a statistically significant reduction was observed in treatment Group 2 in the levels of Tf species only.

CONCLUSION

Riboflavin-loaded nanocarrier incorporated in aloe vera gel showed greater clinical efficacy than PDT alone in the treatment of periimplantitis in chronic hyperglycemic individuals.

The effect of photodynamic therapy in controlling the oral biofilm: A comprehensive overview

Several resistance mechanisms are involved in dental caries, including oral biofilms. An accumulation of bacteria on the surface of teeth is called plaque. Periodontitis and gingivitis are caused by dental plaque. In this review article, we aimed to review the studies associated with the application of photodynamic therapy (PDT) to prevent and treat various microbial biofilm-caused oral diseases in recent decades. There are several studies published in PubMed that have described antimicrobial photodynamic therapy (APDT) effects on microorganisms. Several in vitro and in vivo studies have demonstrated the potential of APDT for treating endodontic, periodontal, and mucosal infections caused by bacteria as biofilms. Reactive oxygen species (ROS) are activated in the presence of oxygen by integrating a nontoxic photosensitizer (PS) with appropriate wavelength visible light. By causing irreversible damage to microorganisms, ROS induces some biological and photochemical events. Testing several wavelengths has been conducted to identify potential PS for APDT. A standard protocol is not yet available, and the current review summarizes findings from dental studies on APDT.

Photoinactivation and Photoablation of Porphyromonas gingivalis

Several types of phototherapy target human pathogens and Porphyromonas gingivitis (Pg) in particular. The various approaches can be organized into five different treatment modes sorted by different power densities, interaction times, effective wavelengths and mechanisms of action. Mode 1: antimicrobial ultraviolet (aUV); mode 2: antimicrobial blue light (aBL); mode 3: antimicrobial selective photothermolysis (aSP); mode 4: antimicrobial vaporization; mode 5: antimicrobial photodynamic therapy (aPDT). This report reviews the literature to identify for each mode (a) the putative molecular mechanism of action; (b) the effective wavelength range and penetration depth; (c) selectivity; (d) in vitro outcomes; and (e) clinical trial/study outcomes as these elements apply to Porphyromonas gingivalis (Pg). The characteristics of each mode influence how each is translated into the clinic.

Antimicrobial photodynamic therapy against oral biofilm: influencing factors, mechanisms, and combined actions with other strategies

Oral biofilms are a prominent cause of a wide variety of oral infectious diseases which are still considered as growing public health problems worldwide. Oral biofilms harbor specific virulence factors that would aggravate the infectious process and present resistance to some traditional therapies. Antimicrobial photodynamic therapy (aPDT) has been proposed as a potential approach to eliminate oral biofilms via in situ-generated reactive oxygen species. Although numerous types of research have investigated the effectiveness of aPDT, few review articles have listed the antimicrobial mechanisms of aPDT on oral biofilms and new methods to improve the efficiency of aPDT. The review aims to summarize the virulence factors of oral biofilms, the progress of aPDT in various oral biofilm elimination, the mechanism mediated by aPDT, and combinatorial approaches of aPDT with other traditional agents.

The role of the light source in antimicrobial photodynamic therapy

Antimicrobial photodynamic therapy (APDT) is a promising approach to fight the growing problem of antimicrobial resistance that threatens health care, food security and agriculture. APDT uses light to excite a light-activated chemical (photosensitiser), leading to the generation of reactive oxygen species (ROS). Many APDT studies confirm its efficacy in vitro and in vivo against bacteria, fungi, viruses and parasites. However, the development of the field is focused on exploring potential targets and developing new photosensitisers. The role of light, a crucial element for ROS production, has been neglected. What are the main parameters essential for effective photosensitiser activation? Does an optimal light radiant exposure exist? And finally, which light source is best? Many reports have described the promising antibacterial effects of APDT in vitro, however, its application in vivo, especially in clinical settings remains very limited. The restricted availability may partially be due to a lack of standard conditions or protocols, arising from the diversity of selected photosensitising agents (PS), variable testing conditions including light sources used for PS activation and methods of measuring anti-bacterial activity and their effectiveness in treating bacterial infections. We thus sought to systematically review and examine the evidence from existing studies on APDT associated with the light source used. We show how the reduction of pathogens depends on the light source applied, radiant exposure and irradiance of light used, and type of pathogen, and so critically appraise the current state of development of APDT and areas to be addressed in future studies. We anticipate that further standardisation of the experimental conditions will help the field advance, and suggest key optical and biological parameters that should be reported in all APDT studies. More in vivo and clinical studies are needed and are expected to be facilitated by advances in light sources, leading to APDT becoming a sustainable, alternative therapeutic option for bacterial and other microbial infections in the future.

Efficacy of indocyanine green and methylene blue mediated-photodynamic therapy on peri-implant outcomes among diabetics with peri-implant mucositis

BACKGROUND

This study aimed to assess the efficacy of indocyanine green (ICG)-mediated versus methylene blue (MB)-mediated photodynamic therapy (PDT) as an adjunct to conventional mechanical debridement (MD) on the peri‑implant clinical, radiographic, microbiological, and immunological outcomes among diabetics with peri‑implant mucositis (pi-M).

METHODS

For this 3-month follow-up study, diabetics having pi-M were randomly divided into 3 groups: group-I (n = 20) subjects received only MD; group-II (n = 20) participants received ICG-mediated adjunct PDT; and group-III (n = 20) subjects received MB-mediated adjunct PDT. Peri-implant clinical (i.e., plaque index [PI], bleeding on probing [BOP], probing depth [PD]), radiographic (crestal bone loss [CBL]), microbiological (Fusobacterium nucleatum [F. nucleatum], Tannerella forsythia [T. forsythia], Prevotella intermedia [P. intermedia], Porphyromonas gingivalis [P. gingivalis], Aggregatibacter actinomycetemcomitans [A. actinomycetemcomitans]), and immunological (interleukin [IL]-6, IL-1β, tumor necrosis factor-alpha [TNF-α]) outcomes were assessed at baseline and 3-month follow-up.

RESULTS

Mean changes between baseline and 3-month follow-up in peri‑implant clinico-radiographic parameters were significantly different between control (PI: 12.42±21.80%; BOP: 12.10±19.30%; PD: 0.45±0.41 mm; CBL: 1.10±1.02 mm) and test groups (ICG-mediated PDT [PI: 26.55±25.80%; BOP: 28.77±29.24%; PD: 0.84±0.62 mm; CBL: 1.98±1.85 mm] and MB-mediated PDT [PI: 27.24±26.15%; BOP: 27.71±28.16%; PD: 0.85±0.63 mm; CBL: 1.95±1.80 mm]), however comparable differences were observed in peri‑implant PI, BOP, PD, and CBL between group-II and group-III participants (p>0.05). The proportions of T. forsythia were significantly reduced in group-II (4.78 × 10⁴ colony-forming unit per milliliter [CFU/mL]) and group-III (4.76 × 10⁴ CFU/mL) as compared to group-I (-4.40 × 10³ CFU/mL) at 3-month follow-up (p = 0.02). No statistically significant differences were observed between the study groups regarding the proportions of the other assessed target bacterial species. For IL-6 (group-I: 210±108; group-II: 298±165; group-III: 277±121 pg/mL; p = 0.03), IL-1β (group-I: 101±95; group-II: 84±98; group-III: 86±74 pg/mL; p = 0.02), and TNF-α (group-I: 336±121; group-II: 385±210; group-III: 366±198 pg/mL; p = 0.03) peri‑implant sulcular fluid [PISF] levels, all three study groups demonstrated statistically significant reduction at 3-month follow-up.

CONCLUSIONS

ICG-mediated and MB-mediated adjunctive PDT showed statistically significant improvements in peri‑implant clinical, radiographic, microbiological, and immunological parameters as compared to conventional MD alone at 3-month follow-up among diabetics with pi-M. However, comparable outcomes were demonstrated by ICG-mediated and MB-mediated adjunctive PDT regarding the assessed peri‑implant parameters.

Clinical applications of antimicrobial photodynamic therapy in dentistry

Given the emergence of resistant bacterial strains and novel microorganisms that globally threaten human life, moving toward new treatment modalities for microbial infections has become a priority more than ever. Antimicrobial photodynamic therapy (aPDT) has been introduced as a promising and non-invasive local and adjuvant treatment in several oral infectious diseases. Its efficacy for elimination of bacterial, fungal, and viral infections and key pathogens such as Streptococcus mutans, Porphyromonas gingivalis, Candida albicans, and Enterococcus faecalis have been investigated by many invitro and clinical studies. Researchers have also investigated methods of increasing the efficacy of such treatment modalities by amazing developments in the production of natural, nano based, and targeted photosensitizers. As clinical studies have an important role in paving the way towards evidence-based applications in oral infection treatment by this method, the current review aimed to provide an overall view of potential clinical applications in this field and summarize the data of available randomized controlled clinical studies conducted on the applications of aPDT in dentistry and investigate its future horizons in the dental practice. Four databases including PubMed (Medline), Web of Science, Scopus and Embase were searched up to September 2022 to retrieve related clinical studies. There are several clinical studies reporting aPDT as an effective adjunctive treatment modality capable of reducing pathogenic bacterial loads in periodontal and peri-implant, and persistent endodontic infections. Clinical evidence also reveals a therapeutic potential for aPDT in prevention and reduction of cariogenic organisms and treatment of infections with fungal or viral origins, however, the number of randomized clinical studies in these groups are much less. Altogether, various photosensitizers have been used and it is still not possible to recommend specific irradiation parameters due to heterogenicity among studies. Reaching effective clinical protocols and parameters of this treatment is difficult and requires further high quality randomized controlled trials focusing on specific PS and irradiation parameters that have shown to have clinical efficacy and are able to reduce pathogenic bacterial loads with sufficient follow-up periods.

Antimicrobial photodynamic therapy using chloro-aluminum phthalocyanine for treating advanced stage-III periodontitis in smoking patients

PURPOSE

To evaluate the bacterial, clinical, and cytokine profile of adjunctive photodynamic therapy using chloro-aluminum phthalocyanine (CAP/aPDT) with root surface debridement (RSD) versus RSD alone in cigarette smokers (CS) and never-smokers (NS) during the period of 6 months.

METHODS

Twenty-nine patients [CS - 14 and NS - 15] were recruited for the trial having stage-III periodontitis. All candidates from the study groups were subjected to a split-mouth treatment technique receiving CAP/aPDT + RSD and RSD alone. Periodontal parameters including plaque levels (PL), bleeding on probing (BP), probing depth (PD), clinical attachment loss (CAL), and marginal bone loss (MBL) were assessed. Polymerase chain reaction (qPCR) assay was used to analyze the copy numbers of Porphyromonas gingivalis (Pg) and Tannerella forsythia (Tf). Levels of tumor necrosis factor-alpha (TNF-α) interleukin (IL)-6 in the crevicular fluid were evaluated by enzyme-linked immunosorbent assay (ELISA).

RESULTS

CAP/aPDT+RSD decreased BP in smokers after 6 months (p < .05). Probing depth and CAL reported statistically significant reductions within both CAP/aPDT+RSD and RSD groups and also within the NS and CS (p < .05). Pg and Tf stayed elevated in smokers at the 6-month evaluation period (p < .01). Only CAP/aPDT+RSD significantly decreased Pg and Tf at 3- and 6-month follow-up in smokers (p < .05). CAP/aPDT+RSD showed decreased IL-6 levels in the NS during the 6-month follow-up (p < .01). TNF-α levels were significantly reduced in the CS group with CAP/aPDT+RSD and RSD alone until 6 months (p < .01).

CONCLUSION

CAP-mediated aPDT along with nonsurgical periodontal therapy helped to improve the bacteriological outcomes among smokers and never-smokers with stage-III CP patients.

Clinical and bacterial outcomes of photodynamic therapy in the treatment of chronic necrotizing ulcerative periodontitis

AIM

To assess the clinical periodontal and microbiological parameters in patients having chronic necrotizing ulcerative periodontitis (NUP) after the administration of adjunctive photodynamic therapy and non-surgical periodontal therapy in smokers, mal-nutrition and HIV positive individuals.

MATERIALS AND METHODS

A total of 30 individuals with NUP were selected for the present clinical trial, where both Group I and Group II had equal number of patients respectively (15 each). The groups were divided on the basis of provision of treatment where patients in Group I underwent scaling and root planing (SRP). Furthermore, Group II patients were subjected to adjunctive phtotodynamic therapy and SRP (aPDT + SRP). Full mouth plaque scores (fmpS), full mouth bleeding on probing (fmBOP), periodontal pocket depth (PPD) and clinical attachment levels (CAL) were the clinical periodontal parameters that were carefully evaluated. Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) and Tannerella forsythia (Tf) were the bacteria species which were evaluated. The assessments were done at baseline, three (3) months and six (6) months respectively.

RESULTS

All periodontal parameters including fmpS, fmBOP, PPD and CAL significantly improved in both Group I and Group II respectively. Group II patients subjected to aPDT + SRP reported higher reduction in mean PPD in comparison to Group I patients at follow up (p<0.05). At follow-up, similar results were also reported for CAL gain where Group II (aPDT +SRP) patients reported higher CAL gain in comparison to patients who underwent SRP only (p<0.05). From baseline to follow-up, all the bacterial levels exhibited reduction in both study groups i.e Group I (SRP) and Group II (aPDT + SRP) respectively (p<0.05). However, Group II patients prominent reduction in the counts of Aa and Tf at the three-month interval, whereas Aa seem to reduce in HIV and smoking individuals at the six-month interval. Moreover, the levels of Pg and Tf significantly reduced at 3 months and only Aa at 6 months in patients with mal-nutrition respectively (p<0.05).

CONCLUSION

The use of photodynamic treatment as an adjunct to scaling and root planing enhanced clinical periodontal results and reduced bacterial content in patients having NUP.

A Systematic Review and Meta-Analysis of Systemic Antibiotic Therapy in the Treatment of Peri-Implantitis

Research has been conducted into the advantages of the systemic administration of antibiotics. The aim of this systematic review and meta-analysis was to assess the efficacy of systemic antibiotic administration in the treatment of peri-implantitis in terms of bleeding on probing (BoP) and probing pocket depth (PPD). Literature searches were performed across PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify randomized controlled trials and observational clinical studies. After peri-implantitis treatment, PPD was reduced by 0.1 mm (p = 0.58; IC 95% [-0.24, 0.47]), indicating a non-significant effect of antibiotic administration on PPD. The BoP odds ratio value was 1.15 (p = 0.5; IC 95% [0.75, 1.75]), indicating that the likelihood of bleeding is almost similar between the test and control groups. Secondary outcomes were found, such as reduced clinical attachment level, lower suppuration and recession, less bone loss, and a reduction in total bacterial counts. In the treatment of peri-implantitis, the systemic antibiotic application reduces neither PPD nor BoP. Therefore, the systemic administration of antibiotics, in the case of peri-implantitis, should be rethought in light of the present results, contributing to address the problem of increasing antibiotic resistance.

The Application of Antimicrobial Photodynamic Therapy (aPDT) in the Treatment of Peri-Implantitis

Background

This literature review evaluates the mechanisms and efficacy of different types of antimicrobial photodynamic therapy (aPDT) for treating peri-implantitis by reviewing existing experimental studies to provide guidance for the clinical application of antibacterial photodynamic therapy (aPDT) in oral implants.

Materials and Methods

From February 2001 to February 2021, we have collected 152 randomized controlled trials of aPDT for peri-implantitis by searching the experimental studies and clinical trials published in PubMed, Embase, Web of Science, and Google Scholar databases via online search. After screening the retrieved literature, we finally selected 10 statistically significant literature for evaluation and review.

Results

Compared with the traditional nonsurgical treatment of peri-implantitis, the aPDT was superior to the traditional mechanical irrigation treatment group in terms of periodontal indexes PD, BOP, PLI, and postoperative effect, and the difference was statistically significant (P < 0.05). Furthermore, the combination of the aPDT and other treatments shows the synergistic antibacterial effect, signifying better clinical effect in many aspects (P < 0.05). In these 10 papers, by comparing the probe depth (PD), bleeding on probing (BOP), synosteosis, and periodontal pathogenic bacteria detection, etc., obtained after treating peri-implantitis by application of the antimicrobial photodynamic therapy, and using the SPSS data analysis software for statistical data processing, we found that the antimicrobial photodynamic therapy combined with other periodontal treatments has a more prominent postoperative effect. Meanwhile, the antibacterial photodynamic therapy with targeted action of photosensitizer has strong specificity to some bacteria, while the synthetic photosensitize for antibacterial photodynamic therapy can show good inactivation effect on broad-spectrum periodontal anaerobes without side effect.

Conclusion

The experimental studies and clinical data of antibacterial photodynamic therapy for treating peri-implantitis show a good postoperative treatment effect. In addition, it did not develop resistance due to the use of antibiotic drugs. Owing to multiple advantages from combining antibacterial photodynamic therapy and other treatments, it is applicable for clinical treatment.

In Vitro Effect of Photodynamic Therapy with Indocyanine Green Followed by 660 nm Photobiomodulation Therapy on Fibroblast Viability

This in␣vitro study sought to assess the effect of repetitive PBMT on the viability of fibroblasts following aPDT with indocyanine green (ICG). In this in␣vitro experimental study, human gingival fibroblasts (HGFs) were obtained and incubated in a culture medium. After reaching 10 000 cells cm^-2 , the cells were divided into five groups of control, aPDT with ICG and 808 nm (energy density of 24 J cm^-2 ), PBMT immediately after aPDT, PBMT with 660 nm (energy density of 7.2 J cm^-2 ) immediately and 24 h after aPDT and PBMT immediately and 24 and 48 h after aPDT in 48-well plates. Cell viability was evaluated using the methyl thiazolyl tetrazolium (MTT) assay after 1, 4 and 7 days of incubation. Statistical analyses were performed using one-way ANOVA. Cell viability significantly decreased in group 2 (P < 0.002). We observed no significant increase in cell viability at any time point in group 3 (P > 0.05). Cell viability significantly increased in groups 4 and 5 after the first day of incubation (P < 0.000). Emission of 660 nm as PBMT for two and three times along with passage of time would increase the viability of HGFs following aPDT with ICG.

Antimicrobial Photodynamic Therapy (aPDT) as a Disinfection and Biomodulation Approach in Implant Dentistry

This article is a highlight of the paper by Choe et al. in this issue of Photochemistry and Photobiology. In that review paper, the disinfection and biomodulation outcomes promoted by antimicrobial photodynamic therapy (aPDT) on peri-implantitis infection were stated and discussed. The killing of the oral pathogens by aPDT is based on the generation of reactive oxygen species (ROS). Besides that, biomodulation can also be provided by aPDT and improve the healing and modulate the inflammatory process. Although aPDT has shown positive effects on the treatment of peri-implantitis disease mainly as a complimentary technique, the authors suggested that more and standardize clinical studies are needed to support the clinical application of aPDT for that purpose. Also, the standardization of parameters related to the light source and photosensitizers is required. In addition, nano-based materials may improve aPDT performance against oral biofilms and could increase the hopes of overcoming dental implant failures.

Clinical, bacterial, and inflammatory outcomes of indocyanine green-mediated photodynamic therapy for treating periimplantitis among diabetic patients: A randomized controlled clinical trial

Background This 6-months randomized controlled clinical trial aimed to assess the efficacy of indocyanine green mediated photodynamic therapy (ICG-PDT) as an adjunct to peri‑implant manual debridement (PIMD) versus PIMD alone among Diabetes Mellitus (DM) patients in the treatment of peri‑implantitis. Methods A total of 48 DM patients having 64 implants were treated with either ICG-PDT + PIMD (n = 35 implants) or PIMD alone (n = 29 implants). Clinical (probing depth [PD], bleeding on probing [BOP], and plaque index [PI]) and radiographic (peri‑implant crestal bone loss [PCBL]) peri‑implant variables were recorded. Bacterial species including Porphyromonas gingivalis and Treponema denticola were evaluated from peri‑implant plaque biofilms. Levels of interleukin (IL)-1β and IL-6 were assessed after the collection of peri‑implant sulcular fluid. All the evaluations were carried out at baseline, 3- and 6-months. The significance level was set to p < 0.05. Results All clinical parameters significantly reduced within both treatment groups (P<0.05). Intra-group comparison indicates that there was statistically significant reduction in PD and suppuration for ICG-PDT group (P<0.05). There was a statistically significant difference in the BOP between ICG-PDT and PIMD groups at both follow-up periods (P<0.001). However, there was a significant difference for PD (P = 0.001), suppuration (P = 0.01), and PCBL (P = 0.04) on 6 months follow-up between ICG-PDT and PIMD groups, respectively. Only ICG-PDT showed a significant reduction in P. gingivalis and T. denticola on both 3 months and 6 months follow-up compared to baseline. PIMD showed a statistically significant reduction only on 3 months follow-up compared to baseline. This reduction was maintained for both the species when dental implants were treated with ICG-PDT. However, PIMD failed to maintain this reduction until 6 months. Only at 3 months assessment that both treatment groups showed statistically significant reduction in IL-1β and IL-6 with no significant difference between the groups. Both biomarkers failed to maintain the reduction in both groups and significantly increased levels for IL-1β was noted at 6 months follow up Conclusion Multiple application of indocyanine-green mediated photodynamic therapy resulted in improved clinical and microbial parameters among type 2 DM subjects in the treatment of peri‑implantitis. This clinical trial was registered in the ClinicalTrials.gov Protocol Registration and Results System with registration record number: NCT04833569.

Effectiveness of photodynamic therapy as an adjunct to topical antiviral therapy in the treatment of herpes labialis: A randomized controlled clinical trial

BACKGROUND

The present clinical trial assessed the effectiveness of photodynamic therapy in association with topical acyclovir in the treatment of herpes labialis in adolescent patients.

MATERIALS AND METHODS

45 individuals with herpes labialis were divided into three groups on the basis of provision of treatment. (a) Group I: Topical acyclovir therapy (AVT) (n = 15, mean age: 17.5 years) (b) Group 2: photodynamic therapy (PDT) (n = 15, mean age:16.8 years) and (c) Group III: AVT + adjunctive PDT (n = 15, mean age: 17.0 years) respectively. HSV-1 quantification and pain scales [visual analogue scale (VAS) and McGill Pain Questionnaire (MPQ)] were calculated. Pro-inflammatory biomarkers including interleukin (IL-6) and tumor necrosis factor-alpha (TNF-α) were quantified using enzyme linked immunosorbent assay (ELISA). Shapiro-Wilk test was used to assess the normality. The Friedman test was employed to compute the comparison for changes recorded in pain scores, proinflammatory cytokines and HSV-1 quantification, whereas Mann-Whitney test was used to analyze the mean values and establish inter-group comparisons. All assessments were performed at baseline, immediate post op, 2-weeks, 4-weeks, 3-months, and 6-months.

RESULTS

A total of 44 individuals completed the clinical trial. According to the data obtained from the clinical assessment, all the study groups reported a decrease in the parameters being observed. However, Group III (anti-viral (acyclovir) therapy + adjunctive PDT) showed a statistically significant decrease, in comparison to Group II (PDT) and Group I [AVT] respectively. The quantified HSV-1 among all groups showed significant reduction among all groups at each successive follow-up. However, Group-III (AVT + PDT) showed statistically significant reduction as compared to Groups I and II, respectively (p < 0.05).

CONCLUSION

Topical anti-viral therapy with adjunctive PDT significantly helped in reducing the pain and pro-inflammatory biomarkers in adolescent herpes labialis patients.

Antimicrobial photodynamic therapy versus antibiotics as an adjunct in the treatment of periodontitis and peri-implantitis: A systematic review and meta-analysis

BACKGROUND

Clinical efficacy of antimicrobial photodynamic therapy (aPDT) as compared to antibiotics in periodontitis and peri-implantitis has been tested in several clinical trials. Yet controversial results were reported. The aim of the present study was to answer the question: "Will adjunctive antimicrobial photodynamic therapy be more effective than antibiotics agent in the treatment of periodontitis and peri-implantitis?".

METHODS

Publications compared outcomes between aPDT and antibiotics in adult patients with periodontitis or peri-implantitis, containing more than 3-month follow-up duration, were involved in the systematic review and meta-analysis. PubMed, EMBASE and Cochrane Central were searched until December of 2020. Clinical parameters including pocket probing depth (PPD), clinical attachment level (CAL), and bleeding on probing (BOP) were evaluated. The risk of bias was assessed by Cochrane Collaboration Tool. Weighted mean differences (WMD), 95 % confidence interval(CI) and heterogeneity were estimated by Review Manager software.

RESULTS

10 trials in periodontitis and 5 trials in peri-implantitis were included. Meta-analysis outcomes revealed equal clinical evidence for aPDT and antibiotics in periodontitis and peri-implantitis. In addition, aPDT significantly reduced the red complex in both diseases. However, owing to the heterogeneity of protocols in articles and the limited number of studies, the comparative conclusion remained unconfirmed.

CONCLUSION

aPDT can be considered as an alternative to antibiotics in the treatment of peri-implantitis and periodontitis. Given that high heterogeneity in outcome was found in this review, future long-term clinical trials with standard aPDT and antibiotic treatment should be tested to arrive at a firm conclusion.

Effectiveness of Riboflavin and Rose Bengal Photosensitizer Modified Adhesive Resin for Orthodontic Bonding

This study aimed to evaluate the effect of riboflavin (RF) and Rose Bengal (RB) photosensitizer modified adhesive resin on the degree of conversion (DC), and antimicrobial capacity after bonded to tooth surface. Different concentrations of RB and RF were prepared by homogenization method. An ultraviolet light source A (UVA) (375 nm wavelength, 3 mW/cm² power) was used for 30 min irradiation. FTIR was performed for control and test adhesives to analyze the DC. Antibacterial testing was performed using the MTT assay. Metal brackets were bonded using the modified adhesives and subjected for SEM examination. The surfaces of teeth and metal brackets were examined at ×10 magnification for assessing adhesive remnant index (ARI) after PDT, 24 h and thermocycling. For DC, control group, 0.1% RB and RF after PDT showed the highest value. SEM imaging indicated lowest growth of Streptococcus mutans over 0.5% of RB-PDT and RF-PDT as compared to the control group. The MTT assay outcomes reported that the activity of S. mutans substantially decreased with the addition of a high amount of either RB or RF (p < 0.01). Mean ARI scores showed a significant difference between all groups. This study concluded that 0.1% of either RB or RF after PDT can be used for bonding orthodontic brackets to the tooth surface with substantial antibacterial properties.

Effectiveness of antimicrobial photodynamic therapy as an adjunct to open flap debridement in patients with aggressive periodontitis

AIM

The aim of the present clinical trial was to evaluate the clinical efficacy of photodynamic therapy (PDT) as an adjunct to open flap debridement (OFD) in the treatment of generalized aggressive periodontitis (GAP).

MATERIALS AND METHODS

The subjects recruited for the study were divided into two groups: 'control group' received treatment through OFD, whereas the test participants were treated with OFD and adjunctive PDT. The clinical periodontal parameters were plaque index (PI), full mouth probing depth (FMPD) and full mouth relative attachment loss (FMRA). The microbial levels of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) and Tannarella forsythia (Tf) were analyzed. All parameters were assessed at baseline and 3 months.

STATISTICAL ANALYSIS

The observed values for all the parameters were reported in mean and standard deviation (mean ± SD). In order to analyse the mean values and inter-group comparisons, the Mann-Whitney U test was employed. The p-value was set at <0.05 to establish a significant difference among the reported values.

RESULTS

A statistically significant improvement for BOP was observed in PDT group in comparison to the control group at 3 months only (p < 0.05). A significant reduction in the microbiological levels for Aa, Pg and Tf in both the study groups was observed. However, no significant differences in microbial levels were observed at any time point when the control and test groups were compared to each other.

CONCLUSION

PDT in conjuction with OFD plays a significant role in reducing the microbial load and improving the clinical periodontal parameters in patients with GAP. Moreover, it is regarded as a safe treatment regimen as no side effects have been reported regarding its use in GAP.

Effectiveness of antimicrobial photodynamic therapy in restoring clinical, microbial, proinflammatory cytokines and pain scores in adolescent patients having generalized gingivitis and undergoing fixed orthodontic treatment

BACKGROUND

The aim of the present study was to evaluate the effectiveness of photodynamic therapy (PDT) on clinical gingival inflammatory parameters, bacterial load, proinflammatory cytokine status, and pain scores in adolescent patients undergoing fixed orthodontic treatment with gingivitis.

METHODS

Thirty adolescent undergoing fixed orthodontic treatment with gingivitis were randomly divided into two groups: Group A - patients undergoing dental scaling (DS) with adjunctive photodynamic therapy (PDT) and Group BDS alone. Clinical gingival parameters including plaque scores, (PS), bleeding on probing (BOP) and probing depth (PD) were assessed. Visual analogue scale (VAS) and McGill Pain Questionnaire (MPQ) were used to report the values of present pain intensity. Crevicular fluid was sampled to quantify the levels of interleukin (IL)-6 and tumor necrosis factor (TNF)-α using enzyme-linked immunosorbent assay. The total bacterial counts for Porphyromonas gingivalis (P. gingivalis) and Tannerella forsythia (T. forsythia) were assessed. All examinations were performed at baseline, 1 week and 4 weeks.

RESULTS

Both the treatment regimens reported statistically significant reduction in PS and BOP (p < 0.05). However, no significant difference was observed in PS and PD values when Group B was compared with Group A (p > 0.05). There was a statistically significant reduction noted for BOP in Group B when compared to Group A (p < 0.05). There was a statistically significant reduction in the microbial counts of T. forsythia in Group A when compared to Group B at week-1 (p < 0.05). During the 4-week follow-up, the counts for T. forsythia significantly increased. No significant changes could be seen in either of the pain scores in both the groups (p > 0.05). Both groups showed statistically significant reduction in the IL-6 and TNF-α levels. However, IL-6 was significantly reduced at 1 week, while TNF-a significantly reduced at 4 weeks of follow up among the participants in Group B.

CONCLUSION

PDT has a positive effect in significantly reducing the periodontal microbial load in established gingivitis in adolescent patients undergoing fixed orthodontic treatment.