Photodynamic therapy during supportive periodontal care: clinical, microbiologic, immunoinflammatory, and patient-centered performance in a split-mouth randomized clinical trial

• Published in: Journal of periodontology (1970) Vol. 85; no. 8; p. e277
• Main Authors: Kolbe, Maria F, Ribeiro, Fernanda V, Luchesi, Vanessa H, Casarin, Renato C, Sallum, Enilson A, Nociti, Jr, Francisco H, Ambrosano, Gláucia M B, Cirano, Fabiano R, Pimentel, Suzana P, Casati, Marcio Z
• Format: Journal Article
• Language: English
• Published: United States 01.08.2014
• Subjects: Adult; Aged; Aggregatibacter actinomycetemcomitans - drug effects; Aggregatibacter actinomycetemcomitans - isolation & purification; Bacterial Load - drug effects; Chronic Periodontitis - drug therapy; Chronic Periodontitis - immunology; Chronic Periodontitis - microbiology; Cytokines - analysis; Dental Scaling - methods; Female; Follow-Up Studies; Humans; Interferon-gamma - analysis; Interleukin-1beta - analysis; Interleukin-4 - analysis; Interleukin-6 - analysis; Male; Middle Aged; Patient Satisfaction; Periodontal Index; Periodontal Pocket - drug therapy; Periodontal Pocket - immunology; Periodontal Pocket - microbiology; Photochemotherapy - methods; Photosensitizing Agents - therapeutic use; Porphyromonas gingivalis - drug effects; Porphyromonas gingivalis - isolation & purification; Prospective Studies; Root Planing - methods; Single-Blind Method; Treatment Outcome; microbiology; pain; cytokines; periodontal pocket; Chronic periodontitis; photochemotherapy
• ISSN: 1943-3670
• DOI: 10.1902/jop.2014.130559

This study investigates the effect of photodynamic therapy (PDT) as monotherapy during supportive periodontal therapy. A split-mouth, randomized controlled trial was conducted in patients with chronic periodontitis (N = 22) presenting at least three residual pockets (probing depth [PD] ≥5 mm with bleeding on probing [BOP]). The selected sites randomly received the following: 1) PDT; 2) photosensitizer (PS); or 3) scaling and root planing (SRP). At baseline and 3 and 6 months, clinical, microbiologic (real-time polymerase chain reaction analyses), cytokine pattern (multiplexed bead immunoassay), and patient-centered (regarding morbidity) evaluations were performed. All therapies promoted similar improvements in clinical parameters throughout the study (P <0.05), except that BOP was not reduced in the PS protocol (P >0.05). Lower levels of Aggregatibacter actinomycetemcomitans were observed in the PDT and SRP protocols at 3 months when compared with the PS protocol (P <0.05). An inferior frequency detection of Porphyromonas gingivalis was observed in the PDT protocol at 3 and 6 months and in the SRP protocol at 6 months from baseline (P <0.05). In addition, PDT protocol presented inferior frequency of P. gingivalis at 3 months when compared with the other therapies (P <0.05). Only patients in the PDT protocol exhibited augmented levels of anti-inflammatory interleukin (IL)-4 and reduced proinflammatory IL-1β and IL-6 throughout the study (P <0.05). Intergroup analyses showed reduced IL-10 and increased interferon-γ and IL-1β levels in the PS protocol when compared with the other therapies during follow-ups (P <0.05). No differences in morbidity were observed between the therapies (P >0.05), although the need for anesthesia was higher in SRP-treated sites (P <0.05). PDT as an exclusive therapy may be considered a non-invasive alternative for treating residual pockets, offering advantages in the modulation of cytokines.