Antimicrobial Photodynamic Therapy and Er,Cr:YSGG Laser-assisted Periodontal Pocket Therapy for Treatment of Aggressive Periodontitis: A Randomized Controlled Clinical Trial
Kirti Chawla, Arundeep K Lamba, Mahesh Verma
Keywords :
Aggressive periodontitis, Er, Cr:YSGG laser, Lasers, Photodynamic therapy
Citation Information :
Chawla K, Lamba AK, Verma M. Antimicrobial Photodynamic Therapy and Er,Cr:YSGG Laser-assisted Periodontal Pocket Therapy for Treatment of Aggressive Periodontitis: A Randomized Controlled Clinical Trial. World J Dent 2022; 13 (5):473-478.
Aim: The aim of this study is to evaluate and compare the clinical effects of Er,Cr:YSGG laser-assisted pocket therapy (ELAPT) and antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) on clinical outcomes of the treatment of aggressive periodontitis.
Materials and methods: Twenty patients with age between 18 and 35 years who were clinically diagnosed with aggressive periodontitis were selected from the outpatient department of periodontics. On the basis of inclusion and exclusion criteria three different sites were selected in each patient and then assigned randomly to three groups of treatment modalities: aPDT (Group I), ELAPT (Group II), or SRP (Group III-control). PD reduction and CAL gain were compared to the baseline values—baseline, 3, 6, and 9 months.
Results: Both the treatment modalities assessed, produced significant improvements in terms of the two outcome variables: PD reduction and CAL gain compared to the baseline values (p < 0 < 0.05) after 9 months, although no significant difference was seen between the two groups for PD reduction and CAL gain.
Conclusion: Within the constraints, this study has shown promising results for the treatment of aggressive periodontitis using both the latest modalities photodynamic therapy (aPDT) and ELAPT. Future research with larger sample size shall be done to evaluate the effects of these modalities.
Clinical significance: The treatment of aggressive periodontitis has always posed a challenge for clinicians, but there have been no established protocols and guidelines for the efficient control of the disease. Conventional adjunctive anti-infectious therapies like systemic antibiotics and local drug delivery are available as an adjunct to SRP but they have not proven to be effective. Antimicrobial photodynamic therapy or laser-assisted pocket therapy could be explored as new possibilities of antibacterial treatment and used as adjunct to SRP for the treatment of aggressive periodontitis.
Armitage GC. Periodontal diagnoses and classification of periodontal diseases. Periodontol 2000 2004;34:9–21. DOI: 10.1046/j.0906-6713.2002.003421.x
Armitage GC, Cullinan MP. Comparison of the clinical features of chronic and aggressive periodontitis. Periodontol 2000 2010; 53:12–27. DOI: 10.1111/j.1600-0757.2010.00353.x
Carvalho LH, D'Avila GB, Leão A, et al. Scaling and root planing, systemicmetronidazole and professional plaque removalin the treatment of chronic periodontitis in a Brazilian population: I. Clinical results. J Clin Periodontol 2004;31:1070–1076. DOI: 10.1111/j.1600-051x.2004.00605.x
Armitage GC, Cullinan MP, Seymour GJ Comparative biology of chronic and aggressive periodontitis: introduction. Periodontol 2000 2010;53:7–11. DOI: 10.1111/j.1600-0757.2010.00359.x
Kinane DF, Hart TC Genes and gene polymorphisms associated with periodontal disease. Crit Rev Oral Biol Med 2003;14(6):430–449. DOI: 10.1177/154411130301400605
Tanner ACR, Socransky SS, Goodson JM. Microbiota of periodontal pockets losing crestal alveolar bone. J Periodontal Res 1984;19(3):279–291. DOI: 10.1111/j.1600-0765.1984.tb00819.x
Iino Y, Hopes RM. The bone resorbing activities in tissue culture of lipopolysaccharides from the bacteria Actinobaccillus actinomycetemcomitans, Bacteroides gingivallis and Capnocythofag aochracea isolated from human mouths. Arch Oral Biol 1984;29(1):59–63. DOI: 10.1016/0003-9969(84)90043-8
Boom-van Noorloos AA, van der Meer JWM, van de Gevel JS, et al. Bacteroides gingivallis stimulates bone resorptionvia interleukin-1 production by mononuclear cells. J Clin Periodontol 1990; 17(7):409–413. DOI: 10.1111/j.1600-051X.1990.tb02338.x
Faveri M, Mayer MP, Feres M, et al. Microbiological diversity of generalized aggressive periodontitis by 16S rRNA clonal analysis. Oral Microbiol Immunol 2008;23(9):112–118. DOI: 10.1111/j.1399-302x.2007.00397.x
Deas DE, Mealey BL. Response of chronic and aggressive periodontitis to treatment. Periodontol 2000 2010;53:154–166. DOI: 10.1111/j.1600-0757.2009.00334.x
Teughels W, Dhondt R, Dekeyser C, et al. Treatment of aggressive periodontitis. Periodontol 2000 2014;65(1):107–133. DOI: 10.1111/prd.12020
Keestra JA, Grosjean I, Coucke W, et al. Non-surgical periodontal therapy with systemic antibiotics in patients with untreated aggressive periodontitis: a systematic review and meta-analysis. J Periodontal Res 2015;50(6):689–706. DOI: 10.1111/jre.12252
Könönen E, Müller HP. Microbiology of aggressive periodontitis. Periodontol 2000 2014;65(1):46–78. DOI: 10.1111/prd.12016
Vieira AR, Albandar JM. Role of genetic factors in the pathogenesis of aggressive periodontitis. Periodontol 2000 2014;65(1):92–106. DOI: 10.1111/prd.12021
Guerrero A, Nibali L, Lambertenghi R, et al. Impact of baseline microbiological status on clinical outcomes in generalized aggressive periodontitis patients treated with or without adjunctive amoxicillin and metronidazole: an exploratory analysis from a randomized controlled clinical trial. J Clin Periodontol 2014;41(11):1080–1089. DOI: 10.1111/jcpe.12299
Guerrero A, Echeverría JJ, Tonetti MS. Incomplete adherence to an adjunctive systemic antibiotic regimen decreases clinical outcomes in generalized aggressive periodontitis patients: a pilot retrospective study. J Clin Periodontol 2007;34(10):897–902. DOI: 10.1111/j.1600-051x.2007.01130.x
Oberoi SS, Dhingra C, Sharma G, et al. Antibiotics in dental practice: how justified are we. Int Dent J 2015;65(1):4–10. DOI: 10.1111/idj.12146
de Oliveira RR, Schwartz-Filho HO, Novaes AB Jr., et al. Antimicrobial photodynamic therapy in the non-surgical treatment of aggressive periodontitis: a preliminary randomized controlled clinical study. J Periodontol 2007;78(6):965–973. DOI: 10.1902/jop.2007.060494
Qin YL, Luan XL, Bi LJ, et al. Comparison of toluidine blue-mediated photodynamic therapy and conventional scaling treatment for periodontitis in rats. J Periodontal Res 2008;43(2):162–167. DOI: 10.1111/j.1600-0765.2007.01007.x
de Oliveira RR, Schwartz-Filho HO, Novaes AB, et al. Antimicrobial photodynamic therapy in the nonsurgical treatment of aggressive periodontitis: Cytokine profile in gingival crevicular fluid, preliminary results. J Periodontol 2009;80(1):98–105. DOI: 10.1902/jop.2009.07046
Ishikawa I, Aoki A, Takasaki AA, et al. Application of lasers in periodontics: true innovation or myth? Periodontol 2000 2009;50:90–126. DOI: 10.1111/j.1600-0757.2008.00283.x
Schwarz F, Aoki A, Becker J, et al. Laser application in non-surgical periodontal therapy: a systematic review. J Clin Periodontol 2008;35(Suppl 8):29–44. DOI: 10.1111/j.1600-051x. 2008.01259.x
Cobb CM. Lasers in periodontics: a review of the literature. J Periodontol 2006;77(4):545–564. DOI: 10.1902/jop.2006.050417
Raffetto N. Lasers for initial periodontal therapy. Dent Clin North Am 2004;48:923–936. DOI: 10.1016/j.cden.2004.05.007
Gilaberte Y, Rezusta A, Juarranz A, et al. (2021) Editorial: Antimicrobial photodynamic therapy: a new paradigm in the fight against infections. Front Med 8:788888. DOI: 10.3389/fmed.2021.788888
Polat E, Kang K. Natural photosensitizers in antimicrobial photodynamic therapy. Biomedicines 2021;9(6):584. DOI: 10.3390/biomedicines9060584. PMID: 34063973; PMCID: PMC8224061.
de Oliveira GJ, Cominotte MA, Beraldo TP, et al. A microscopic analysis of the effects of root surface scaling with different power parameters of Er,Cr:YSGG laser. Microsc Res Tech 2015;78(6):529–535. DOI: 10.1002/jemt.22505
Iwai K, Shi YW, Endo M, et al. Penetration of high-intensity Er:YAG laser light emitted by IR hollow optical fibers with sealing caps in water. Appl Opt 2004;43(12):2568–2571. DOI: 10.1364/AO.43.002568
Hakki SS, Korkusuz P, Berk G, et al. Comparison of Er,Cr:YSGG laser and hand instrumentation on the attachment of periodontal ligament fibroblasts to periodontally diseased root surfaces: an in vitro study J Periodontol 2010;81(8):1216–1225. DOI: 10.1902/jop.2010.090715
Gutknecht N, Van Betteray C, Ozturan S, et al. Laser supported reduction of specific microorganisms in the periodontal pocket with the aid of an Er,Cr:YSGG laser: a pilot study. Scientific World Journal 2015;2015:450258 DOI: 10.1155/2015/450258
Gilthorpe MS, Zamzuri AT, Griffiths GS, et al. Unification of the “burst” and “linear” theories of periodontal disease progression: a multilevel manifestation of the same phenomenon. J Dent Res 2003;82(3):200–205. DOI: 10.1177/154405910308200310
Wilson M, Burns T, Pratten J, et al. Bacteria in supra gingival plaque samples can be killed by low-power laser light in the presence of a photosensitizer. J Appl Bacteriol 1995;78(5):569–574. DOI: 10.1111/j.1365-2672.1995.tb03101.x
Theodoro LH, Silva SP, Pires JR, et al. Clinical and microbiological effects of photodynamic therapy associated with nonsurgical periodontal treatment. A 6-month follow-up. Lasers Med Sci 2012;27(4):687–693. DOI: 10.1007/s10103-011-0942-x
Dyer B, Sung EC. Minimally invasive periodontal treatment using the Er,Cr:YSGG laser: a 2 year retrospective preliminary clinical study. Open Dent J 2012;6:74–78. DOI: 10.2174/1874210601206010074
Oda S, Nitta H, Setoguchi T, et al. Current concepts and advances in manual and power-driven instrumentation. Periodontol 2000 36:45–58. DOI: 10.1111/j.1600-0757.2004.03674.x
Obeid PR, D'Hoore W, Bercy P. Comparative clinical responses related to the use of various periodontal instrumentation. J Clin Periodontol 2004;31(3):193–199. DOI: 10.1111/j.0303-6979.2004.00467.x
de Melo Soares MS, D'Almeida Borges C, de MendonçaInvernici M, et al. Antimicrobial photodynamic therapy as adjunct to non-surgical periodontal treatment in smokers: a randomized clinical trial. Clin Oral Investig 2019;23(8):3173–3182. DOI: 10.1007/s00784-018-2740-3. PMID: 30392080.
Cadore UB, Reis MBL, Martins SHL, et al. Multiple sessions of antimicrobial photodynamic therapy associated with surgical periodontal treatment in patients with chronic periodontitis J Periodontol 2019;90(4):339–349. DOI: 10.1002/JPER.18-0373. PMID: 30383298.
Franco TPM, Dos Santos APP, Canabarro A. The effects of repeated applications of antimicrobial photodynamic therapy in the treatment of residual periodontal pockets: a systematic review. Lasers Med Sci 2019;34(5):855–863. DOI: 10.1007/s10103-018-02703-2
Polansky R, Haas M, Heschl A, et al. Clinical effectiveness of photodynamic therapy in the treatment of periodontitis. J Clin Periodontol 200936(7): 36: 575–580. DOI: 10.1111/j.1600-051x.2009.01412.x
Kelbauskiene S, Maciulskiene V. A pilot study of Er,Cr:YSGG laser therapy used as an adjunct to scaling and root planing in patients with early and moderate periodontitis. Stomatologija 2007;9(1):21–26.
Gupta M, Lamba AK, Verma M, et al. Comparison of periodontal open flap debridement versus closed debridement with Er,Cr:YSGG laser. Aust Dent J 2013;58(1):41–49. DOI: 10.1111/adj.12021
AlAhmari F, Ahmed HB, Al-Kheraif AA, et al. Effectiveness of scaling and root planning with and without adjunct antimicrobial photodynamic therapy in the treatment of chronic periodontitis among cigarette-smokers and never-smokers: a randomized controlled clinical trial. Photodiagnosis Photodyn Ther 2019;25:247–252. DOI: 10.1016/j.pdpdt.2019.01.006
Borekci T, Meseli SE, Noyan U, et al. Efficacy of adjunctive photodynamic therapy in the treatment of generalized aggressive periodontitis: a randomized controlled clinical trial. Lasers Surg Med 2019;51(2):167–175. DOI: 10.1002/lsm.23010. PMID: 30095173.
