Adjunctive Application of Antimicrobial Photodynamic Therapy in Nonsurgical Periodontal Treatment: A Review of Literature

Abstract

Periodontal disease is caused by dental plaque biofilms, and the removal of these biofilms from the root surface of teeth plays a central part in its treatment. The conventional treatment for periodontal disease fails to remove periodontal infection in a subset of cases, such as those with complicated root morphology. Adjunctive antimicrobial photodynamic therapy (aPDT) has been proposed as an additional treatment for this infectious disease. Many periodontal pathogenic bacteria are susceptible to low-power lasers in the presence of dyes, such as methylene blue, toluidine blue O, malachite green, and indocyanine green. aPDT uses these light-activated photosensitizer that is incorporated selectively by bacteria and absorbs a low-power laser/light with an appropriate wavelength to induce singlet oxygen and free radicals, which are toxic to bacteria. While this technique has been evaluated by many clinical studies, some systematic reviews and meta-analyses have reported controversial results about the benefits of aPDT for periodontal treatment. In the light of these previous reports, the aim of this review is to provide comprehensive information about aPDT and help extend knowledge of advanced laser therapy.

Effects of photodynamic therapy in periodontal treatment: A randomized, controlled clinical trial

“…These differences could be explained by penetration of the epithelium and connective tissue by the photosensitizing agent used in PDT, with destruction of the bacteria (Kömerik, Wilson, & Poole, 2000) but without damage to the periodontal tissue (Kömerik et al, 2003;Sigusch, Pfitzner, Albrecht, & Glockmann, 2005). As a photosensitizing agent, methylene blue is effective at inactivating Gram-positive and -negative bacteria (Kikuchi et al, 2015;Moan & Berg, 1991) through the production of free radicals and singlet oxygen, which cause irreversible damage to the bacterial cytoplasmic membrane (Garcez, Nuñez, Hamblin, & Ribeiro, 2008). Thus, the combination of SRP + PDT may be useful in cases of increased bacterial burden of A. actinomycetemcomitans.…”

Engineering of relevant photodynamic processes through structural modifications of metallotetrapyrrolic photosensitizers

“…Antimicrobial PDT has only found clinical application in dermatology and dentistry, where 5-aminolevulanic acid and phenothiazinium dyes (i.e. methylene blue, toluidine blue, PP904), respectively, are used [295,[299][300][301]. The number of clinical trials on photodynamic treatment of various types of infections in increasing, but this field is still in its infancy.…”

Antimicrobial photodynamic inactivation: a bright new technique to kill resistant microbes

“…However, aPDI has been shown to kill biofilm-grown cells both in vitro and in vivo [10]. This anti-biofilm application has found particular application in dental infections such as periodontitis [11] and peri-implantitis [12]. Moreover, infections in burns or damaged tissue suffer from a compromised blood supply, so systemically administered antibiotics fail to reach the site of infection in sufficient concentrations.…”