Photodynamic Therapy in Orthodontics: A Literature Review

In vitro effect of photodynamic therapy with two photosensitizers on Streptococcus mutans load around metal and ceramic brackets bonded to enamel

BACKGROUND AND OBJECTIVES

The inherent surface porosities of ceramic brackets can enhance bacterial plaque accumulation. This study assessed the in-vitro effect of photodynamic therapy (PDT) with two photosensitizers (PSs) on Streptococcus mutans (S. mutans) load around metal and ceramic brackets bonded to enamel.

MATERIALS AND METHODS

In this in vitro experimental study, 48 sound premolars extracted for orthodontic reasons were randomly assigned to two groups (n = 24) for bonding to metal and ceramic brackets. After bracket bonding, the tooth-bracket assemblies were inoculated with S. mutans, and each group was randomly divided into three subgroups (n = 8) of control, PDT with toluidine blue O (TBO) and 635 nm laser, and PDT with indocyanine green (ICG) and 808 nm laser. The colony count was quantified in each subgroup, and analyzed by repeated measures ANOVA.

RESULTS

Ceramic brackets showed a significantly higher colony count than metal brackets in the control subgroup by 7.057 log10 CFUs/mL (P < 0.05). PDT, irrespective of PS type, significantly decreased the bacterial count around both ceramic (by 7.616 log10 CFUs/mL in the ICG and 7.594 log10 CFUs/mL in the TBO subgroup) and metal (by 7.512 log10 CFUs/mL in the ICG and 7.505 log10 CFUs/mL in the TBO subgroup) brackets (P < 0.05). The difference in bacterial count was not significant between the ceramic and metal bracket groups after PDT (P = 0.541 for ICG and P = 0.101 for TBO).

CONCLUSION

Within the limitations of this in vitro study and as an attempt to predict what might happen in vivo, the results showed that PDT significantly decreased the bacterial load around metal and ceramic brackets bonded to enamel, irrespective of the type of PS. Thus, PDT may be considered as a possibly efficient strategy to minimize the bacterial load especially around ceramic brackets.

The Biofilm Removal and Bactericidal Effect of an 810-nm High-Power Laser on an Orthodontic Bracket Surface: An In Vitro Study

Objective: The present study aimed to analyze the biofilm removal and bactericidal effect of laser treatment alone and laser combined with ultrasonic scaling on orthodontic brackets. It also assessed whether the use of a laser can improve the efficiency of biofilm removal and bactericidal effect compared with traditional ultrasonic instrumentation. Background Data: Streptococcus mutans (S. mutans) can lead to white spots and dental caries. Orthodontic brackets make teeth cleaning more difficult, and biofilms or bacteria on the surface of brackets worsen the oral environment, which may cause some oral diseases. Laser can be used for biofilm removal and killing bacteria on the surface of an object through thermal, photochemical, and pressure effects, which is widely used in the treatment of oral diseases. Methods: A total of 600 mandibular incisor brackets were collected for this study. Among these, 320 unused brackets were used for the S. mutans crystal violet assay (n = 160) and for S. mutans live/dead bacterial staining (n = 160). Another 280 brackets, obtained from patients who had undergone therapy for over two years, were used for the mature multispecies biofilms removal assay (n = 120) and multispecies bacterial live/dead bacterial staining (n = 160). Ultrasonic scaling, laser, and laser combined with ultrasonic scaling were applied to the labial surface of brackets covered by S. mutans biofilm or mature multispecies biofilms. Specifically, we used the following three methods: ultrasonic scaling for 10 sec without laser; 810-nm laser (Doctor Smile, Italy, LA5D0 001.1) with 0.3-mm spot size at total 21.2 kJ/cm2 for 10 sec; and 810-nm laser at total 10.6 kJ/cm2 for 5 sec, followed by ultrasonic scaling for 5 sec. The 810-nm diode laser removed biofilms with a power of 1.5 W and a power density of 2.12 kW/cm2. The S. mutans biofilm was examined using crystal violet assay, and scanning electron microscopy (SEM) was used for mature multispecies biofilms to evaluate the effect of the three methods on biofilm removal. Live/dead bacterial staining was used to examine the bactericidal effect on remaining biofilms by confocal laser scanning microscopy (CLSM). Results: For S. mutans biofilm, the optical density (OD) value and live/dead bacterial ratio in the laser and the laser combined with ultrasonic scaling groups were significantly lower than those in the ultrasonic scaling group (p < 0.05); moreover, the OD value and the live/dead bacterial ratio in laser treatment combined with ultrasonic scaling and laser treatment alone showed no significant difference (p > 0.05). For mature multispecies biofilms, the percentage of biofilm coverage after treatment was higher in the laser group than in the ultrasonic scaling group (p < 0.05) and lower in the laser combined with ultrasonic scaling group than in the ultrasonic scaling group (p < 0.05), and live/dead bacterial staining showed that laser treatment alone killed the most bacteria, followed by laser treatment combined with ultrasonic scaling, while ultrasonic scaling alone seldom killed bacteria. Conclusions: Laser treatment alone has a better bactericidal effect and can also remove more S. mutans biofilm than ultrasonic scaling alone, but it fails to remove more mature multispecies biofilms. Laser treatment combined with ultrasonic scaling can remove more S. mutans biofilm and mature multispecies biofilms than ultrasonic scaling alone and also has a better bactericidal effect than ultrasonic scaling alone on a bracket surface.

Photobiomodulation in Orthodontics: Mechanisms and Clinical Efficacy for Faster Tooth Movement

Accelerated orthodontics has revolutionized traditional dental practices by employing innovative techniques to expedite tooth movement and enhance treatment outcomes. Among these advancements, low-level laser therapy (LLLT) has emerged as a promising adjunctive method that offers a non-invasive and efficient approach to accelerate orthodontic tooth movement. By harnessing the power of low-level lasers, LLLT aims to stimulate cellular activity, promote bone remodeling, and reduce treatment duration, thereby revolutionizing the landscape of orthodontic care. In this review, we discuss the mechanism of action, methods, efficacy, advantages, limitations, and future scope of LLLT, uncovering its transformative impact on the field of accelerated orthodontics.

The effects of low-level laser therapy and photodynamic therapy on oral health of fixed orthodontics patients. A systematic review and meta-analysis

Objective To investigate the effect of low-level laser and photodynamic therapy on the oral health, and periodontal tissue of fixed orthodontic patients and the effect of using photobiomodulation methods compared to routine plaque removal methods and the amount of plaque in fixed orthodontic patients. Method and materials First, the title and summary of related articles were collected by using the search strategy electronic databases PUBMED, EMBASE, Cochrane's CENTRAL, Scopus, ISI and all the articles that were published from the beginning to February 2023 were evaluated. The title, abstracts and full texts of all the relevant studies were reviewed respectively, and those meeting the criteria were entered into our study. Finally, the quality of the studies was examined and the results of the studies were pooled by means of random effects inverse variance meta-analysis. Results Eighteen randomized studies, conducted between 2015 and December 2022, were selected for meta-analysis. Five studies were conducted as split-mouth, twelve as parallel-group, and one as a cross-over design. Among the studies, five examined the effects of low-level laser therapy and twelve assessed the effects of photodynamic therapy. The meta-analysis revealed that photodynamic therapy significantly reduced probing depth compared to scaling (MD=-0.2 mm, P<0.001), though the difference does not seem to be clinically significant. But no significant differences between photodynamic therapy and scaling or low-level laser therapy and control groups in terms of plaque index, or bleeding on probing, gingival crevicular fluid volume, gingival recession, clinical attachment loss, bacterial load and concentrations of inflammatory substances across multiple follow-up periods. Conclusion Moderate evidence indicates that photodynamic therapy (PDT) is comparable to conventional methods in improving oral health, as measured by periodontal indices, inflammatory proteins, bacterial colonies, and white spot lesions, making it a suitable alternative. Limited evidence suggests low-level laser therapy (LLLT) may improve oral health, particularly addressing caries, but further research is needed.

The Effects and Mechanisms of PBM Therapy in Accelerating Orthodontic Tooth Movement

Malocclusion is one of the three major diseases, the incidence of which could reach 56% of the imperiled oral and systemic health in the world today. Orthodontics is still the primary method to solve the problem. However, it is clear that many orthodontic complications are associated with courses of long-term therapy. Photobiomodulation (PBM) therapy could be used as a popular way to shorten the course of orthodontic treatment by nearly 26% to 40%. In this review, the efficacy in cells and animals, mechanisms, relevant cytokines and signaling, clinical trials and applications, and the future developments of PBM therapy in orthodontics were evaluated to demonstrate its validity. Simultaneously, based on orthodontic mechanisms and present findings, the mechanisms of acceleration of orthodontic tooth movement (OTM) caused by PBM therapy were explored in relation to four aspects, including blood vessels, inflammatory response, collagen and fibers, and mineralized tissues. Also, the cooperative effects and clinical translation of PBM therapy in orthodontics have been explored in a growing numbers of studies. Up to now, PBM therapy has been gaining popularity for its non-invasive nature, easy operation, and painless procedures. However, the validity and exact mechanism of PBM therapy as an adjuvant treatment in orthodontics have not been fully elucidated. Therefore, this review summarizes the efficacy of PBM therapy on the acceleration of OTM comprehensively from various aspects and was designed to provide an evidence-based platform for the research and development of light-related orthodontic tooth movement acceleration devices.

Porphyrin-associated fluorescence spectroscopy (Photogen®) for the optical diagnosis of dental biofilm in orthodontic treatment: an observational clinical trial

OBJECTIVE

This study assessed the presence of dental biofilm with fluorescence spectroscopy associated with porphyrin (Photogen®) in users of orthodontic appliances.

METHODS

This cross-sectional observational clinical trial included 21 patients with metallic orthodontic fixed appliances. The presence of biofilm was evaluated by fluorescence spectroscopy (Evince-MMÓptics. São Carlos-SP, Brazil) with a porphyrin photo-evidence device (Photogen®). Digital images of the buccal surface of the upper anterior teeth (central and lateral incisors and canines) without and with porphyrin were analyzed using the histogram R (red) function in ImageJ software. The results were analyzed using the maximum and mode values of the red pixels from the histograms. The statistical analysis considered the significance level of 5%.

RESULTS

The maximum values and modes of the red pixels were significantly higher in biofilms analyzed by porphyrin-associated optical spectroscopy compared to optical spectroscopy alone.

CONCLUSIONS

Porphyrin-associated fluorescence spectroscopy was able to detect dental biofilm in the oral environment of patients with orthodontic treatment. This method better evidenced the presence of biofilm on the buccal surfaces of the upper teeth compared to that observed with fluorescence spectroscopy without porphyrin.

Synthesis, Cellular Uptake, and Photodynamic Activity of Oligogalactosyl Zinc(II) Phthalocyanines

A series of di-α-substituted zinc(II) phthalocyanines with different number of galactose moieties, ranging from 1 to 8, namely Pc-gal_n (n=1, 2, 4, and 8) were designed and synthesized. The synthesis involved the copper-catalyzed azide-alkyne cycloaddition reaction of a mono- or dialkynyl zinc(II) phthalocyanine with an acetyl-protected galactosyl azide or its dendritic derivative with four acetyl-protected galactosyl groups, followed by removal of the acetyl protecting groups via alkaline hydrolysis. In N,N-dimethylformamide, these oligogalactosyl phthalocyanines were non-aggregated as shown by the strong Q-band absorption and fluorescence emission. Owing to the di-α-substitution, they also behaved as efficient singlet oxygen generators upon light irradiation with a singlet oxygen quantum yield of 0.84. The spectroscopic and photophysical properties were not affected by the number of galactosyl units. In contrast, the compounds became significantly aggregated and quenched in phosphate-buffered saline. Their cellular uptake was then studied using a range of cell lines, which generally followed the order Pc-gal₁ >Pc-gal₂ ≈Pc-gal₄ >Pc-gal₈ . Interestingly, the di-galactosyl analogue exhibited selective uptake against HeLa human cervical carcinoma cells through an energy-dependent pathway instead of the expected asialoglycoprotein receptor. Upon light irradiation, it could effectively kill the cells with a half-maximal inhibitory concentration of 0.58 μM.

An oxygen-economical nano-photosensitizer with a high photodynamic therapeutic outcome via simultaneous reduction of the cellular respiration and oxygen depletion of PDT

The development of photodynamic nanomedicines that can alleviate intratumoral oxygen deficiency during photodynamic therapy (PDT) is of great significance for improving the therapeutic outcome of solid tumors characterized by severe hypoxia. Massive oxygen consumption due to vigorous cellular respiration, i.e., mitochondrial-associated oxidative phosphorylation (OXPHOS), is another major cause of severe tumor hypoxia in addition to insufficient oxygen supply. Moreover, oxygen depletion during PDT further exacerbates the shortage of intratumoral oxygen. In this work, we engineered a novel oxygen-economical nano-photosensitizer via co-encapsulation of an OXPHOS inhibitor (ATO) and a newly developed type-I photosensitizer (IPS) into a polymeric micelle of PEG-b-PCL. By controlling the length of hydrophobic PCL segments, we successfully optimized the micelle size to around 30 nm for enhanced tumor penetration. The orchestration of the two functional components, ATO and IPS, can simultaneously hinder the two major tumor oxygen-consuming pathways, where ATO targets mitochondrial complex III to inhibit cellular respiration, while IPS generates ROS through a low oxygen-consuming type-I photochemical pathway, enabling remarkable PDT efficacies in both hypoxic cells and a 4T1 tumor-bearing BALB/c mouse model. This work sheds new light on the construction of nano-photosensitizers to rejuvenate PDT against hypoxic solid tumors.

Photoactivation of Curcumin Doped Poly-Lactic-Co-Glycolic Acid Nanoparticles in Rat Model with Fixed Orthodontic Appliances

This study aimed to evaluate the antimicrobial effect of curcumin doped poly-lactic-co-glycolic acid nanoparticles (Cur-PLGA-Nps)-mediated antimicrobial photodynamic therapy (aPDT), as well as the probiotics on S. mutans in rats with fixed orthodontic appliances. Orthodontic appliances were ligated to the right maxillary of the rats. After the oral colonization of S. mutans, the rats were then treated in four groups including Cur-PLGA-Nps, light-emitting diode, Cur-PLGA-Nps-mediated aPDT, and probiotic (Lactobacillus acidophilus). After that, the S. mutans counts and the gtfB gene expression of S. mutans were determined on days 4, 7, 15, and 30. Probiotic and Cur-PLGA-Nps-mediated aPDT groups significantly reduced the count of S. mutans in a time-dependent manner (P < 0.05). So, probiotics and Cur-PLGA-Nps-mediated aPDT were able to reduce S. mutans more than other groups on the 30th day. Also, there was no considerable difference between Cur-PLGA-Nps-mediated aPDT and probiotic groups in bacterial growth inhibition. The expression level of gtfB gene was significantly downregulated at all-time intervals after exposure to Cur-PLGA-Nps-mediated aPDT compared with untreated bacteria (P < 0.05). According to the results, simultaneous use of Cur-PLGA-Nps-mediated aPDT and probiotic therapeutic approaches can be suggested to increase effectiveness.

Orthodontic Bracket Removal Using LASER-Technology-A Short Systematic Literature Review of the Past 30 Years

Background: Since fixed orthodontic treatment is widely spread and one of its inconveniences is bracket removal, as this affects enamel integrity as well as being a cause of discomfort to the patient, studies have searched for the most adequate bracket removal technique, many of them focusing on using laser-technology. Methods: Our review focused on articles published investigating methods of orthodontic bracket removal using laser technology in the last 30 years. Results: 19 relevant studies were taken into consideration after a thorough selection. Different types of laser devices, with specific settings and various testing conditions were tested and the investigators presented their pertinent conclusions. Conclusions: Most studies were performed using ceramic brackets and the best results in terms of prevention of enamel loss, temperature stability for the tooth as well as reduced chair time were obtained with Er:YAG lasers.