DTUK2910

November 29-December 5, 201016 Perio Tribune United Kingdom Edition Meisel and Kocher identified in their review 2005 the “pre- requisites and further demands” in regards to PAD in Periodon- tology: suitability of the photo- sensitising dyes, optimisation of efficacy, determination of irradi- ation device as well as exposure time, etc. Today PAD can be regard- ed as a helpful adjutant in biofilm management. Its in- dication in clinical dentistry varies from Cariology to Peri- implantitis covering Endo- dontics and Periodontology. Application in Perio Use of PAD in Periodontology is multifaceted as an adjutant af- ter non-surgical or in conjunc- tion with surgical approaches. Interestingly, Azarpazhooh et al (2010) performed a system- atic review and meta analysis for the use of PAD in Period- ontology and concluded: “PDT as an independent treatment or as an adjunct to SRP was not superior to control treatment of SRP. Therefore, the routine use of PDT for clinical manage- ment of periodontitis cannot be recommended.” Once one understands mechanisms of action of PAD, as briefly discussed above, and starts to critically appraise the systematic review performed by the group of Azarpazhooh et al. a major shortcoming be- comes eminent – there was no appraisal of the studies includ- ed, in regards of suitable selec- tion of photosensitiser, adequate light source and timing. Cor- rect conclusion would have re- ferred to the kind of PS used and the question if photobiological principles of light have been disregarded. It is sad to admit that even applying the highest crite- ria for appraisal according to the Cochrane library one may generate confusing con- clusions if authors are not fa- miliar with the review topic. In 2009, Ramos de Oliviera et al. managed to demonstrate a statistically significant reduc- tion in TNF -a level 30 days fol- lowing treatment when PAD used without SRP. Similar re- sults were achieved by Braham et al.(2009). An in vivo study by Si- gusch et al. (2010) showed “that the adjuvant application of the described PDT method is appropriate to reduce peri- odontal inflammatory symp- toms and to successfully treat infection with F. nucleatum.” The results of Allan et al. (2007) using Toluidine blue “in- dicate that PDT may be an effec- tive alternative to conventional modalities in the treatment of periodontal disease.” Andersen et al. (2007) com- pared the use of Pad to SRP and concluded that “Within the lim- its of the present study, it can be concluded that SRP combined with photodisinfection leads to significant improvements of the investigated parameters over the use of SRP alone.” Milanezi de Almeida et al. (2008) induced periodontal bone loss in rats by ligature and treated with PAD. Their conclusion: “PDT may be an effective alternative for control of bone loss in furcation areas in periodontitis.” Kömerik et al. (2003) researched the lethal action of Toluidine blue as PS on Porphyromonas Gingivalis and concluded “The results of this study show that Toluidine blue-mediated lethal photosen- sitisation of P. gingivalis is pos- sible in vivo and that this results in decreased bone loss. These findings suggest that photody- namic therapy may be useful as an alternative approach for the antimicrobial treatment of periodontitis.” Application for treatment of Peri-implantitis Hayek et al (2005) published a study comparing conventional therapy versus PAD for treat- ment of ligature induced peri- implantitis in dogs. They con- cluded that the non invasive PAD technique could be used to reduce pathological microor- ganism in peri-implantitis. Shibli et al. (2003) examined the efficacy of PAD applica- tion alone in ligature induced peri-implantitis in dogs and con- cluded that complete elimina- tion of pathogens was achieved in some cases. Dörtbudak et al. (2001) re- searched microbial decontami- nation on peri-implantitis af- fected IMZ implants in vivo and identified a significant reduction after PAD application. Baron et al (2000) reviewed 29 papers on regenerative meth- ods in regards to regenera- tion of peri-implantitis affected sites and concluded: “Of all tested treatment methods, the combination of guided bone regeneration and augmenta- tion with demineralised freeze- dried bone resulted in the most favorable results regarding bone gain and reosseointe gration.” Application in Cariology Williams et al (2002) researched the bactericidal efficacy of Tolu- idine blue and variable energy on Streptococcus mutans. The results were extremely encour- aging: “The system was highly effective in killing TBO-treated Streptococcus mutans NCTC 10449 in stirred planktonic suspension, killing at least 109 cfu/ml. Antibacterial action in- creased as the delivered energy dose increased.” The study of Lima et al. (2009) “evaluated the effect of PACT (Photodynamic antimi- crobial therapy) on dentine car- ies produced in situ.” They came to the following conclusions: “PACT was effective in killing oral microorganisms present in dentine caries produced in situ and may be a useful technique for eliminating bacteria from dentine carious lesions before restoration.” Steier et al. researched the efficacy of PAD bovine root ca- nal dentine previously infected with Enterococcus Faecalis mo- noculture Biofilm. Especially with today’s trends of minimalistic inter- vention and using adhesive dentistry the use of PAD may prevent excessive hard tissue re- moval and help maintain great amounts of dentin. Major ben- efit of course is the conservation on tooth vitality. Application in Endodontics An in vivo study performed by Bonsor et al. (2006) concluded that “Results indicate that the use of a chelating agent acting as a cleaner and disrupter of the biofilm and photo-activated disinfection to kill bacteria is an effective alternative to the use of hypochlorite as a root canal cleaning system.” Another in vivo study pub- lished as well in 2006 by the group of Bonsor researched the ability of PAD to compliment conventional RCT disinfection and concluded that “The PAD system offers a means of de- stroying bacteria remaining af- ter using conventional irrigants in endodontic therapy.” Williams et al. (2006) tested the efficacy of PAD on Fuso- bacterium nucleatum, Pepto- streptococcus micros, Prevotella intermedia and Streptococcus intermedius and concluded that “PAD killed endodontic bacteria at statistically significant levels compared to controls.” Garcez et al (2008), in an in vivo study, researched the “Antimicrobial Effects of Pho- todynamic Therapy on Patients with Necrotic Pulps and Peri- apical Lesion” and their results suggested “that the use of PDT added to endodontic treatment leads to an enhanced decrease of bacterial load and may be an appropriate approach for the treatment of oral infections.” The research hypothesis of Bergmans et al. (2007) was: “To test the hypothesis that photo- activated disinfection (PAD) has a bactericidal effect on patho- gens inoculated in root canals, with emphasis on biofilm for- mation/destruction.” Their con- clusions were: Photo-activated disinfection is not an alternative but a possible supplement to the existing protocols for root canal disinfection as the interaction between light (diode laser) and associated dye (TBO) provides a broad-spectrum effect.” The research goal of Garcez et al. (2006) was “To compare the effectiveness of antimicrobi- al photodynamic therapy (PDT), standard endodontic treatment and the combined treatment to eliminate bacterial biofilms present in infected root canals.” Their results: “Endodontic therapy alone reduced bacterial bioluminescence by 90 per cent while PDT alone reduced biolu- minescence by 95 per cent. The combination reduced biolumi- nescence by >98 per cent, and importantly the bacterial re- growth observed 24 hours after treatment was much less for the combination (P<0.0005) than for either single treatment.” page 15DTß Fig1 - SRP - Pocket debridement using US Fig2 - Instillation of the PS (Toluidine blue) into the pocket Fig3 - Tip of light source (Aseptim Plus, Denfotex) in situ Fig4 - Application of light (120 sec) Fig5 - Clinical picture showing advanced bone loss. Teeth involved demonstrated no mobility. Tooth 24 received a RCT Fig6 - PAD disinfection once mechanical debridement completed and prior to GBR Fig7 - Clinical picture showing localised peri-implantitis. Similar to the case above once mechanical debridement completed PAD disinfection applied prior to GTR