Clinical and microbiological effects of photodynamic therapy applied in non-surgical treatment of periodontitis

Zoran Arsić; Radovan Jovanović; Aleksandar Djordjević; Meliha Šehalić; Dragan Marjanović; Mirko Mikić; Zoran Vlahović; Raša Mladenović

doi:10.2298/VSP200304060A

Zoran Arsić University of Priština/Kosovska Mitrovica, Faculty of Medical Sciences, Department of Dentistry, Kosovska Mitrovica, Serbia
Radovan Jovanović University of Priština/Kosovska Mitrovica, Faculty of Medical Sciences, Department of Dentistry, Kosovska Mitrovica, Serbia
Aleksandar Djordjević University of Priština/Kosovska Mitrovica, Faculty of Medical Sciences, Department of Dentistry, Kosovska Mitrovica, Serbia
Meliha Šehalić University of Priština/Kosovska Mitrovica, Faculty of Medical Sciences, Department of Dentistry, Kosovska Mitrovica, Serbia
Dragan Marjanović University of Priština/Kosovska Mitrovica, Faculty of Medical Sciences, Department of Dentistry, Kosovska Mitrovica, Serbia
Mirko Mikić University of Montenegro, Faculty of Medicine, Department of Dentistry, Podgorica, Montenegro
Zoran Vlahović University of Priština/Kosovska Mitrovica, Faculty of Medical Sciences, Department of Dentistry, Kosovska Mitrovica, Serbia
Raša Mladenović University of Kragujevac, Faculty of Medical Sciences, Department of Dentistry, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP200304060A

Keywords: aggregatibacter actinomyctemcomitans;, periodontitis;, photochemotherapy;, polymerase chain reaction;, porphyromonas gingivalis;, treponema denticola;, treatment outcome

Abstract

Background/Aim. Treatment of periodontitis undergoes several treatment phases. Non-surgical periodontal treatment (NSPT) represents the basic treatment stage, and it is applied to all the patients undergoing periodontal treatment. Adjunctive antimicrobial photodynamic therapy (aPDT) is one of several contemporary and relatively new possibilities with a role to inactivate microorganisms responsible for the occurrence and progression of the disease. The aim of this study was to comparatively analyze the clinical and microbiological effects of the NSPT alone, as well as combined with aPDT. Methods. A split-mouth method design was used in a prospective randomized controlled trial. The following clinical parameters were registered and monitored: plaque index (PI), bleeding on probing, probing depth (PD), and clinical attachment level (CAL). The presence of microorganisms Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Treponema denticola was detected by the polymerase chain reaction (PCR) method. Samples were tested before the therapy, as well as three months after the therapy. Therapeutic modalities of NSPT and NSPT with adjunct aPDT were examined. Results. All of the analyzed clinical parameters proved statistically significant improvement after the application of both treatment modalities (p < 0.001). Microbiological analyses showed that the total number of microorganisms was statistically significantly lower after the application of both methods (p < 0.001). Following the treatment, there was a statistically significantly reduced number of microorganisms Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Treponema denticola (p < 0.001). NSPT combined with aPDT led to a statistically significant improvement of both clinical parameters and microbiological status compared to NSPT applied on its own. Conclusion. The study showed improvement of all clinical indicators after the application of both treatment modalities. The total number of microorganisms was reduced as well as the number of specific microorganisms. Combining aPDT with NSPT led to a statistically significantly higher reduction in the number of microorganisms compared to NSPT alone.

References

Di Benedetto A, Gigante I, Colucci S, Grano M. Periodontal dis-ease: linking the primary inflammation to bone loss. Clin Dev Immunol 2013; 2013: 503754.

Socransky S, Haffajee AD, Cugini MA, Smith C, Kent RL Jr. Mi-crobial complexes in subgingival plaque. J Clin Periodontol 1998; 25(2): 134–44.

Socransky S, Haffajee AD. Dental biofilms: difficult therapeutic targets. Periodontol 2000 2002; 28: 12–55.

Haubek D, Johansson A. Pathogenicity of the highly leukotoxic JP2 clone of Aggregatibacter actinomycetemcomitans and its geographic dissemination and role in aggressive periodontitis. J Oral Microbiol 2014; 6: doi: 10.3402/jom.v6.23980.

Henderson B, Ward JM, Ready D. Aggregatibacter (Actinobacil-lus) actinomycetemcomitans: a triple A* periodontopathogen? Periodontol 2000 2010; 54(1): 78‒105.

Keestra JA, Grosjean I, Coucke W, Quirynen M, Teughels W. Non-surgical periodontal therapy with systemic antibiotics in pa-tients with untreated chronic periodontitis: a systematic re-view and meta-analysis. J Periodontal Res 2015; 50(3): 294‒314.

Chitsazi MT, Kashefimehr A, Pourabbas R, Shirmohammadi A, Ghasemi Barghi V, Daghigh Azar B. Efficacy of Subgingival Application of Xanthan-based Chlorhexidine Gel Adjunctive to Full-mouth Root Planing Assessed by Real-time PCR: A Microbiologic and Clinical Study. J Dent Res Dent Clin Dent Prospects 2013; 7(2): 95‒101.

Cobb CM. Clinical significance of non-surgical periodontal therapy: an evidence-based perspective of scaling and root planing. J Clin Periodontol 2002; 29 Suppl 2: 6‒16.

Akram Z, Safii SH, Vaithilingam RD, Baharuddin NA, Javed F, Vohra F. Efficacy of non-surgical periodontal therapy in the management of chronic periodontitis among obese and non-obese patients: a systematic review and meta-analysis. Clin Oral Investig 2016; 20(5): 903‒14.

Akram Z, Baharuddin NA, Vaithilingam RD, Rahim ZH, Chinna K, Krishna VG, et al. Effect of nonsurgical periodontal treat-ment on clinical periodontal variables and salivary resistin levels in obese Asians. J Oral Sci 2017; 59(1): 93–102.

Cortellini P, Buti J, Pini Prato G, Tonetti MS. Periodontal regen-eration compared with access flap surgery in human intra-bony defects 20-year follow-up of a randomized clinical trial: tooth retention, periodontitis recurrence and costs. J Clin Periodon-tol 2017; 44(1): 58‒66.

Moreno Villagrana AP, Gómez Clavel JF. Antimicrobial or sub-antimicrobial antibiotic therapy as an adjunct to the nonsurgi-cal periodontal treatment: a meta-analysis ISRN Dent 2012; 2012: 581207.

Cherkaoui A, Schrenzel J, Giannopoulou C. Effect of Periodontal Therapy With Amoxicillin-Metronidazole on Pharyngeal Car-riage of Penicillin- and Erythromycin-Resistant Viridans Streptococci. J Periodontol 2016; 87(5): 539‒47.

Bonito AJ, Lux L, Lohr KN. Impact of local adjuncts to scaling and root planing in periodontal disease therapy: a systematic review. J Periodontol 2005; 76(8): 1227‒36.

Novaes AB Jr, Schwartz-Filho HO, de Oliveira RR, Feres M, Sato S, Figueiredo LC. Antimicrobial photodynamic therapy in the non-surgical treatment of aggressive periodontitis: microbio-logical profile. Lasers Med Sci 2012; 27(2): 389‒95.

Rakašović D, Lazić Z, Rakonjac B, Soldatović I, Janković S, Magić M, et al. Efficiency of photodynamic therapy in the treatment of peri-implantitis: A three-month randomized controlled clinical trial. Srp Arh Celok Lek 2016; 144(9‒10): 478‒84.

Atieh MA. Photodynamic therapy as an adjunctive treatment for chronic periodontitis: A meta-analysis. Lasers Med Sci 2010; 25(4): 605‒13.

Al Habashneh R, Asa’ad FA, Khader Y. Photodynamic therapy in periodontal and peri-implant diseases. Quintessence Int 2015; 46(8): 677‒90.

Chrepa V, Kotsakis GA, Pagonis TC, Hargreaves KM. The effect of photodynamic therapy in root canal disinfection: A system-atic review. J Endod 2014; 40(7): 891‒8.

Paschoal MA, Tonon CC, Spolidório DM, Bagnato VS, Giusti JS, Santos-Pinto L. Photodynamic potential of curcumin and blue LED against Streptococcus mutans in a planktonic culture. Photodiagnosis Photodyn Ther 2013; 10(3): 313‒9.

Silness J, Loe H. Periodontal disease in pregnancy: II. Corela-tion between oral hygiene and periodontal condition. Acta Odontol Scand 1964; 22: 121‒35.

Saxer UP, Mühlemann HR. Motivation and education. SSO Schweiz Monatsschr Zahnheilkd 1975; 85(9): 905‒19. (Ger-man)

Quirynen M, Bollen CM, Vandekerckhove BN, Dekeyser C, Papaio-annou W, Eyssen H. Full- vs. partial-mouth disinfection in the treatment of periodontal infections: short-term clinical and microbiological observations. J Dent Res 1995; 74(8): 1459‒67.

Akram Z, Rahim ZH, Taiyeb-Ali TB, Shahdan MS, Baharuddin NA, Vaithilingam RD, et al. Resistin as potential biomarker for chronic periodontitis: a systematic review and meta-analysis. Arch Oral Biol 2017; 73: 311‒20.

Renvert S, Persson GR. A systematic review on the use of resid-ual probing depth, bleeding on probing and furcation status following initial periodontal therapy to predict further at-tachment and tooth. J Clin Periodontol 2002; 29 Suppl 3: 82‒9; discussion 90‒1.

Adriaens PA, Adriaens LM. Effects of nonsurgical periodontal therapy on hard and soft tissues. Periodontol 2000 2004; 36: 121–45.

Umeda M, Takeuchi Y, Noguchi K, Huang Y, Koshy G, Ishikawa I. Effects of nonsurgical periodontal therapy on the microbiota. Periodontol 2000 2004; 36: 98‒120.

Husejnagic S, Lettner S, Laky M, Georgopoulos A, Moritz A, Rausch-Fan X. Photoactivated disinfection in periodontal treatment:A randomized controlled clinical split-mouth trial. J Periodontol 2019; 90(11): 1260‒9.

Petrović MS, Kannosh IY, Milašin JM, Mihailović DS, Obradović RR, Bubanj SR, et al. Clinical, microbiological and cytomor-phometric evaluation of low-level laser therapy as an adjunct to periodontal therapy in patients with chronic periodontitis. Int J Dent Hyg 2018; 16(2): e120‒7.

Kumawat RM, Ganvir SM, Hazarey VK, Qureshi A, Purohit HJ. Detection of Porphyromonas gingivalis and Treponema denti-cola in chronic and aggressive periodontitis patients: A com-parative polymerase chain reaction study. Contemp Clin Dent 2016; 7(4): 481‒6.

Corrêa MG, Oliveira DH, Saraceni CHC, Ribeiro FV, Pimentel SP, Cirano FR, et al. Short-term microbiological effects of photodynamic therapy in non-surgical periodontal treatment of residual pockets: A split-mouth RCT. Lasers Surg Med 2016; 48(10): 944–50.

Eggert FM, McLeod MH, Flowerdew G. Effects of smoking and treatment status on periodontal bacteria: Evidence that smok-ing influences control of periodontal bacteria at the mucosal surface of the gingival crevice. J Periodontol 2001; 72(9): 1210‒20.

Checchi L, Gatto MR, Checchi V, Carinci F. Bacteria prevalence in a large Italian population sample: A clinical and microbio-logical study. J Biol Regul Homeost Agents 2016; 30(2 Suppl 1): 199‒208.

Nociti FH Jr, Casati MZ, Duarte PM. Current perspective of the impact of smoking on the progression and treatment of periodontitis. Periodontol 2000 2015; 67(1): 187‒210.

Xue D, Tang L, Bai Y, Ding Q, Wang P, Zhao Y. Clinical effica-cy of photodynamic therapy adjunctive to scalingand root planning in the treatment of chronic periodontitis:a systematic review and meta-analysis. Photodiagn Photodyn Ther 2017; 18: 119–27.

Katsikanis F, Strakas D, Vouros I. The application of antimi-crobial photodynamic therapy (aPDT, 670 nm) and diode la-ser (940 nm) as adjunctive approach in the conventional cause-related treatment of chronic periodontal disease: a ran-domized controlled split-mouth clinical trial. Clin Oral Inves-tig 2020; 24(5): 1821‒7.

Monteiro MF, Casati MZ, Taiete T, Sallum EA, Nociti FH Jr, Ruiz KG, et al. Salivary carriage of periodontal pathogens in generalized aggressive periodontitis familiesnt J Paediatr Dent 2014; 24(2): 113–21.

Lulic M, Leiggener Görög I, Salvi GE, Ramseier CA, Mattheos N, Lang NP.. One-year outcomes of repeated adjunctive photo-dynamic therapy during periodontal maintenance: A proof-of-principle randomized-controlled clinical trial. J Clin Periodon-tol 2009; 36(8): 661–6.

Moreira AL, Novaes AB Jr, Grisi MF, Taba M, Souza SL, Palioto DB, et al. Antimicrobial Photodynamic Therapy as an Adjunct to Non-Surgical Treatment of Aggressive Periodontitis: A Split-Mouth Randomized Controlled Trial. J Periodontol 2015; 86(3): 376–86.

Assem NZ, Alves MLF, Lopes AB, Gualberto EC Jr, Garcia VG, Theodoro LH. Antibiotic therapy as an adjunct to scaling and root planing in smokers: a systematic review and meta-analysis Braz Oral Res 2017; 31: e67.

de Melo Soares MS, D'Almeida Borges C, de Mendonça Invernici M, Frantz FG, de Figueiredo LC, de Souza SLS, et al. Antimicrobial photodynamic therapy as adjunct to non-surgical periodontal treatment in smokers: a randomized clinical trial. Clin Oral Investig 2019; 23(8): 3173‒82.

Theodoro LH, Assem NZ, Longo M, Alves MLF, Duque C, Stipp RN, et al. Treatment of periodontitis in smokers with multiple sessions of antimicrobial photodynamic therapy or systemic antibiotics: A randomized clinical trial. Photodiagnosis Pho-todyn Ther 2018; 22: 217‒22.

Bundidpun P, Srisuwantha R, Laosrisin N. Clinical effects of photodynamic therapy as an adjunct to full mouth ultrasonic scaling and root planing in treatment of chronic periodontitis. Laser Ther 2018; 27(1): 33‒9.