Adjuvant antimicrobial photodynamic therapy improves periodontal health and reduces inflammatory cytokines in patients with type 1 diabetes mellitus*

Paula de Oliveira Cunha; Isabela Rodrigues Gonsales; Sebastião Luiz Aguiar Greghi; Adriana Campos Passanezi Sant'Ana; Heitor Marques Honório; Carlos Antonio Negrato; Mariana Schutzer Ragghianti Zangrando; Carla Andreotti Damante

doi:10.1590/1678-7757-2024-0258

Authors

Paula de Oliveira Cunha Universidade de São Paulo. Faculdade de Odontologia de Bauru. Departamento de Prótese e Periodontia, Bauru https://orcid.org/0000-0003-0890-6037
Isabela Rodrigues Gonsales Universidade de São Paulo. Faculdade de Odontologia de Bauru. Departamento de Prótese e Periodontia, Bauru https://orcid.org/0000-0002-7222-8093
Sebastião Luiz Aguiar Greghi Universidade de São Paulo. Faculdade de Odontologia de Bauru. Departamento de Prótese e Periodontia https://orcid.org/0000-0003-2530-3705
Adriana Campos Passanezi Sant'Ana Universidade de São Paulo. Faculdade de Odontologia de Bauru. Departamento de Prótese e Periodontia https://orcid.org/0000-0001-5640-9292
Heitor Marques Honório Universidade de São Paulo. Faculdade de Odontologia de Bauru. Departamento de Prótese e Periodontia https://orcid.org/0000-0003-0231-3409
Carlos Antonio Negrato Universidade de São Paulo., Faculdade de Medicina de Bauru, https://orcid.org/0000-0003-3720-1183
Mariana Schutzer Ragghianti Zangrando Universidade de São Paulo. Faculdade de Odontologia de Bauru. Departamento de Prótese e Periodonti https://orcid.org/0000-0003-0286-7575
Carla Andreotti Damante https://orcid.org/0000-0002-6782-8596

DOI:

https://doi.org/10.1590/1678-7757-2024-0258

Keywords:

Photodynamic therapy., Lasers, Periodontitis, Diabetes Mellitus, Type 1, Cytokines

Abstract

Antimicrobial photodynamic therapy (aPDT) is an adjuvant treatment to scaling and root planing (SRP) which improves periodontal health. It may be beneficial to patients with systemic diseases, such as type 1 diabetes mellitus. Objective: This randomized clinical trial evaluated the adjunctive effect of aPDT on the periodontal treatment of patients with type 1 diabetes (T1D). Methodology: 38 patients were included in the study and divided into four groups: DSRP – T1D patients treated with SRP; CSRP – normoglycemic patients treated with SRP; DPDT – T1D patients treated with SRP + aPDT (methylene blue and red laser); CPDT – normoglycemic patients treated with SRP + aPDT. , Periodontal clinical parameters and inflammatory cytokines in crevicular fluid were recorded at baseline and then after 1, 3 and 6 months. The clinical endpoint for treatment was evaluated after 6 months. Results: Adjuvant aPDT treatment resulted in reduction of probing depth after 3 months (0.38 mm - p<0.05) on T1D patients and in control group after 6 months (0.66 mm - p<0.05). Reduction of clinical attachment levels was similar for both treatments in control patients (p>0.05). There was a significant reduction of TNF-α in crevicular fluid in both groups treated with aPDT (p<0.05). The T1D (65%) and normoglycemic (72%) groups achieved the clinical endpoint after both treatments (p>0.05). Conclusions: Adjuvant aPDT provided additional benefits in improving periodontal clinical parameters and reducing inflammatory cytokines in both T1D and normoglycemic patients. However, normoglycemic patients showed greater clinical improvements compared to T1D patients following adjuvant aPDT treatment.

Downloads

Download data is not yet available.

References

- American Diabetes Association. 3. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S28-S37. doi: 10.2337/dc18-S003

» https://doi.org/10.2337/dc18-S003

- Polak D, Sanui T, Nishimura F, Shapira L. Diabetes as a risk factor for periodontal disease: plausible mechanisms. Periodontol 2000. 2020;83(1):46-58. doi: 10.1111/prd.12298

» https://doi.org/10.1111/prd.12298

- Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Clin Periodontol. 2018;45 Suppl 20:S149-S161. doi: 10.1111/jcpe.12945

» https://doi.org/10.1111/jcpe.12945

- Dicembrini I, Serni L, Monami M, Caliri M, Barbato L, Cairo F, et al. Type 1 diabetes and periodontitis: prevalence and periodontal destruction-a systematic review. Acta Diabetol. 2020;57(12):1405-12. doi: 10.1007/s00592-020-01531-7

» https://doi.org/10.1007/s00592-020-01531-7

- Löe H. Periodontal disease: the sixth complication of diabetes mellitus. Diabetes Care. 1993;16(1):329-34.

- Valle LA, Lopes MM, Zangrando MS, Sant'Ana AC, Greghi SL, Rezende ML, et al. Blue photosensitizers for aPDT eliminate Aggregatibacter actinomycetemcomitans in the absence of light: an in vitro study. J Photochem Photobiol B. 2019;194:56-60. doi: 10.1016/j.jphotobiol.2019.03.005

» https://doi.org/10.1016/j.jphotobiol.2019.03.005

- Passanezi E, Damante CA, Rezende ML, Greghi SL. Lasers in periodontal therapy. Periodontol 2000. 2015;67(1):268-91. doi: 10.1111/prd.12067

» https://doi.org/10.1111/prd.12067

- Lulic M, Leiggener Görög I, Salvi GE, Ramseier CA, Mattheos N, Lang NP. One-year outcomes of repeated adjunctive photodynamic therapy during periodontal maintenance: a proof-of-principle randomized-controlled clinical trial. J Clin Periodontol. 2009;36(8):661-6. doi: 10.1111/j.1600-051X.2009.01432.x

» https://doi.org/10.1111/j.1600-051X.2009.01432.x

- Moreira AL, Novaes AB Jr, Grisi MF, Taba M Jr, 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. doi: 10.1902/jop.2014.140392

» https://doi.org/10.1902/jop.2014.140392

- Campanile VS, Giannopoulou C, Campanile G, Cancela JA, Mombelli A. Single or repeated antimicrobial photodynamic therapy as adjunct to ultrasonic debridement in residual periodontal pockets: clinical, microbiological, and local biological effects. Lasers Med Sci. 2015;30(1):27-34. doi: 10.1007/s10103-013-1337-y

» https://doi.org/10.1007/s10103-013-1337-y

- Theodoro LH, Assem NZ, Longo M, Alves ML, 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 Photodyn Ther. 2018;22:217-22. doi: 10.1016/j.pdpdt.2018.04.003

» https://doi.org/10.1016/j.pdpdt.2018.04.003

- Damante CA, Cunha PO, Negrato CA, Greghi SL, Zangrando MS, Sant'Ana AC. Adjunct antimicrobial photodynamic therapy improves short-term periodontal status in type 1 diabetes mellitus patients. In: Longo L, editor. Proceedings of advances in laserology: selected papers of Laser Florence. Bologna: Filodiritto editore; 2020. p. 52-6.

- Andrade PV, Alves VT, Carvalho VF, Rodrigues MF, Pannuti CM, Holzhausen M, et al. Photodynamic therapy decrease immune-inflammatory mediators levels during periodontal maintenance. Lasers Med Sci. 2017;32(1):9-17. doi: 10.1007/s10103-016-2076-7

» https://doi.org/10.1007/s10103-016-2076-7

- Barbosa FI, Araújo PV, Machado LJ, Magalhães CS, Guimarães MM, Moreira AN. Effect of photodynamic therapy as an adjuvant to non-surgical periodontal therapy: Periodontal and metabolic evaluation in patients with type 2 diabetes mellitus. Photodiagnosis Photodyn Ther. 2018;22:245-50. doi: 10.1016/j.pdpdt.2018.04.013

» https://doi.org/10.1016/j.pdpdt.2018.04.013

- Mirza S, Khan AA, Al-Kheraif AA, Khan SZ, Shafqat SS. Efficacy of adjunctive photodynamic therapy on the clinical periodontal, HbA1c and advanced glycation end product levels among mild to moderate chronic periodontal disease patients with type 2 diabetes mellitus: a randomized controlled clinical trial. Photodiagnosis Photodyn Ther. 2019;28:177-82. doi: 10.1016/j.pdpdt.2019.08.003

» https://doi.org/10.1016/j.pdpdt.2019.08.003

- Santos NC, Andere NM, Araujo CF, Marco AC, Santos LM, Jardini MA, et al. Local adjunct effect of antimicrobial photodynamic therapy for the treatment of chronic periodontitis in type 2 diabetics: split-mouth double-blind randomized controlled clinical trial. Lasers Med Sci. 2016;31(8):1633-40. doi: 10.1007/s10103-016-2030-8

» https://doi.org/10.1007/s10103-016-2030-8

- Al-Momani MM. Indocyanine-mediated antimicrobial photodynamic therapy promotes superior clinical effects in stage III and grade C chronic periodontitis among controlled and uncontrolled diabetes mellitus: a randomized controlled clinical trial. Photodiagnosis Photodyn Ther. 2021;35:102379. doi: 10.1016/j.pdpdt.2021.102379

» https://doi.org/10.1016/j.pdpdt.2021.102379

- Claudio MM, Nuernberg MA, Rodrigues JV, Belizário LC, Batista JA, Duque C, et al. Effects of multiple sessions of antimicrobial photodynamic therapy (aPDT) in the treatment of periodontitis in patients with uncompensated type 2 diabetes: a randomized controlled clinical study. Photodiagnosis Photodyn Ther. 2021;35:102451. doi: 10.1016/j.pdpdt.2021.102451

» https://doi.org/10.1016/j.pdpdt.2021.102451

- Muzaheed, AcharyaS, Hakami AR, Allemailem KS, Alqahtani K, Al Saffan A, et al. Effectiveness of single versus multiple sessions of photodynamic therapy as adjunct to scaling and root planing on periodontopathogenic bacteria in patients with periodontitis. Photodiagnosis Photodyn Ther. 2020;32:102035. doi: 10.1016/j.pdpdt.2020.102035

» https://doi.org/10.1016/j.pdpdt.2020.102035

- Abduljabbar T, Vohra F, Javed F, Akram Z. Antimicrobial photodynamic therapy adjuvant to non-surgical periodontal therapy in patients with diabetes mellitus: a meta-analysis. Photodiagnosis Photodyn Ther. 2017;17:138-46. doi: 10.1016/j.pdpdt.2016.11.008

» https://doi.org/10.1016/j.pdpdt.2016.11.008

- Silva-Junior PG, Abreu LG, Costa FO, Cota LO, Esteves-Lima RP. The effect of antimicrobial photodynamic therapy adjunct to non-surgical periodontal therapy on the treatment of periodontitis in individuals with type 2 diabetes mellitus: a systematic review and meta-analysis. Photodiagnosis Photodyn Ther. 2023;42:103573. doi: 10.1016/j.pdpdt.2023.103573

» https://doi.org/10.1016/j.pdpdt.2023.103573

- Grzech-Lesniak K, Gaspirc B, Sculean A. Clinical and microbiological effects of multiple applications of antibacterial photodynamic therapy in periodontal maintenance patients: a randomized controlled clinical study. Photodiagnosis Photodyn Ther. 2019;27:44-50. doi: 10.1016/j.pdpdt.2019.05.028

» https://doi.org/10.1016/j.pdpdt.2019.05.028

- Feres M, Retamal-Valdes B, Faveri M, Duarte P, Shibli J, Soares GM, et al. Proposal of a clinical endpoint for periodontal trials: the treat-to-target approach. J Int Acad Periodontol. 2020;22(2):41-53.

- Macedo GO, Novaes AB Jr, Souza SL, Taba M Jr, Palioto DB, Grisi MF. Additional effects of aPDT on nonsurgical periodontal treatment with doxycycline in type II diabetes: a randomized, controlled clinical trial. Lasers Med Sci. 2014;29(3):881-6. doi: 10.1007/s10103-013-1285-6

» https://doi.org/10.1007/s10103-013-1285-6

- Yang X, Zhang J, Ni J, Ouyang B, Wang D, Luo S, et al. Toll-like receptor 4-mediated hyper-responsiveness of gingival epithelial cells to lipopolysaccharide in high-glucose environments. J Periodontol. 2014;85(11):1620-8. doi: 10.1902/jop.2014.140087

» https://doi.org/10.1902/jop.2014.140087

- Duarte PM, Bezerra JP, Miranda TS, Feres M, Chambrone L, Shaddox LM. Local levels of inflammatory mediators in uncontrolled type 2 diabetic subjects with chronic periodontitis. J Clin Periodontol. 2014;41(1):11-8. doi: 10.1111/jcpe.12179

» https://doi.org/10.1111/jcpe.12179

- Ribeiro FV, Mendonça AC, Santos VR, Bastos MF, Figueiredo LC, Duarte PM. Cytokines and bone-related factors in systemically healthy patients with chronic periodontitis and patients with type 2 diabetes and chronic periodontitis. J Periodontol. 2011;82(8):1187-96. doi: 10.1902/jop.2011.100643

» https://doi.org/10.1902/jop.2011.100643

- Stadler AF, Angst PD, Arce RM, Gomes SC, Oppermann RV, Susin C. Gingival crevicular fluid levels of cytokines/chemokines in chronic periodontitis: a meta-analysis. J Clin Periodontol. 2016;43(9):727-45. doi: 10.1111/jcpe.12557

» https://doi.org/10.1111/jcpe.12557

- Alblowi J, Tian C, Siqueira MF, Kayal RA, McKenzie E, Behl Y, et al. Chemokine expression is upregulated in chondrocytes in diabetic fracture healing. Bone. 2013;53(1):294-300. doi: 10.1016/j.bone.2012.12.006

» https://doi.org/10.1016/j.bone.2012.12.006

- Luchesi VH, Pimentel SP, Kolbe MF, Ribeiro FV, Casarin RC, Nociti FH Jr, et al. Photodynamic therapy in the treatment of class II furcation: a randomized controlled clinical trial. J Clin Periodontol. 2013;40(8):781-8. doi: 10.1111/jcpe.12121

» https://doi.org/10.1111/jcpe.12121

- Kolbe MF, Ribeiro FV, Luchesi VH, Casarin RC, Sallum EA, Nociti FH Jr, et al. Photodynamic therapy during supportive periodontal care: clinical, microbiologic, immunoinflammatory, and patient-centered performance in a split-mouth randomized clinical trial. J Periodontol. 2014;85(8):e277-86. doi: 10.1902/jop.2014.130559

» https://doi.org/10.1902/jop.2014.130559

- Duarte PM, Feres M, Yassine LL, Soares GM, Miranda TS, Faveri M, et al. Clinical and microbiological effects of scaling and root planing, metronidazole and amoxicillin in the treatment of diabetic and non-diabetic subjects with periodontitis: a cohort study. J Clin Periodontol. 2018;45(11):1326-35. doi: 10.1111/jcpe.12994

» https://doi.org/10.1111/jcpe.12994

- Sgolastra F, Petrucci A, Gatto R, Marzo G, Monaco A. Photodynamic therapy in the treatment of chronic periodontitis: a systematic review and meta-analysis. Lasers Med Sci. 2013;28(2):669-82. doi: 10.1007/s10103-011-1002-2

» https://doi.org/10.1007/s10103-011-1002-2

- Azaripour A, Dittrich S, Van Noorden CJF, Willershausen B. Efficacy of photodynamic therapy as adjunct treatment of chronic periodontitis: a systematic review and meta-analysis. Lasers Med Sci. 2018;33(2):407-23. doi: 10.1007/s10103-017-2383-7

» https://doi.org/10.1007/s10103-017-2383-7

- Salvi GE, Stähli A, Schmidt JC, Ramseier CA, Sculean A, Walter C. Adjunctive laser or antimicrobial photodynamic therapy to non-surgical mechanical instrumentation in patients with untreated periodontitis: a systematic review and meta-analysis. J Clin Periodontol. 2020;47 Suppl 22:176-98. doi: 10.1111/jcpe.13236

» https://doi.org/10.1111/jcpe.13236

- Chambrone L, Wang HL, Romanos GE. Antimicrobial photodynamic therapy for the treatment of periodontitis and peri-implantitis: an American Academy of Periodontology best evidence review. J Periodontol. 2018;89(7):783-803. doi: 10.1902/jop.2017.170172

» https://doi.org/10.1902/jop.2017.170172

- Damante CA. Laser parameters in systematic reviews. J Clin Periodontol. 2021;48(4):550-2. doi: 10.1111/jcpe.13421

» https://doi.org/10.1111/jcpe.13421

- Alwaeli HA, Al-Khateeb SN, Al-Sadi A. Long-term clinical effect of adjunctive antimicrobial photodynamic therapy in periodontal treatment: a randomized clinical trial. Lasers Med Sci. 2015;30(2):801-7. doi: 10.1007/s10103-013-1426-y

» https://doi.org/10.1007/s10103-013-1426-y

- Braun A, Dehn C, Krause F, Jepsen S. Short-term clinical effects of adjunctive antimicrobial photodynamic therapy in periodontal treatment: a randomized clinical trial. J Clin Periodontol. 2008;35(10):877-84. doi: 10.1111/j.1600-051X.2008.01303.x

» https://doi.org/10.1111/j.1600-051X.2008.01303.x

- Novaes AB Jr, Schwartz-Filho HO, Oliveira RR, Feres M, Sato S, Figueiredo LC. Antimicrobial photodynamic therapy in the non-surgical treatment of aggressive periodontitis: microbiological profile. Lasers Med Sci. 2012;27(2):389-95. doi: 10.1007/s10103-011-0901-6

» https://doi.org/10.1007/s10103-011-0901-6

- Petelin M, Perkic K, Seme K, Gašpirc B. Effect of repeated adjunctive antimicrobial photodynamic therapy on subgingival periodontal pathogens in the treatment of chronic periodontitis. Lasers Med Sci. 2015;30(6):1647-56. doi: 10.1007/s10103-014-1632-2

» https://doi.org/10.1007/s10103-014-1632-2

- Sigusch BW, Engelbrecht M, Völpel A, Holletschke A, Pfister W, Schütze J. Full-mouth antimicrobial photodynamic therapy in Fusobacterium nucleatum-infected periodontitis patients. J Periodontol. 2010l;81(7):975-81. doi: 10.1902/jop.2010.090246

» https://doi.org/10.1902/jop.2010.090246

- Skaleric E, Petelin M, Gašpirc B. Antimicrobial photodynamic therapy in treatment of aggressive periodontitis (stage III, grade C periodontitis): a comparison between photodynamic therapy and antibiotic therapy as an adjunct to non-surgical periodontal treatment. Photodiagnosis Photodyn Ther. 2023;41:103251. doi: 10.1016/j.pdpdt.2022.103251

» https://doi.org/10.1016/j.pdpdt.2022.103251

- Santamaria P, Sari A, Nibali L. Molecular profiling of gingival crevicular fluid fails to distinguish between infrabony and suprabony periodontal defects. J Clin Periodontol. 2023;50(10):1315-25. doi: 10.1111/jcpe.13849

» https://doi.org/10.1111/jcpe.13849

- Lin SY, Sun JS, Lin IP, Hung MC, Chang JZ. Efficacy of adjunctive local periodontal treatment for type 2 diabetes mellitus patients with periodontitis: a systematic review and network meta-analysis. J Dent. 2024;148:105212. doi: 10.1016/j.jdent.2024.105212

» https://doi.org/10.1016/j.jdent.2024.105212

Adjuvant antimicrobial photodynamic therapy improves periodontal health and reduces inflammatory cytokines in patients with type 1 diabetes mellitus*

Authors

DOI:

Keywords:

Abstract

Downloads

References

Downloads

Published

Issue

Section

License

How to Cite

Language

Information

Keywords