Antimicrobial Photodynamic Therapy in Patients With Periodontal Disease and Type 2 Diabetes Mellitus
Condition: Periodontal Diseases; Diabetes Mellitus, Type 2; Periodontitis; Periodontal Pocket; Periodontal Attachment Loss; Periodontal Inflammation
MeSH terms: Periodontitis; Periodontal Diseases; Periodontal Pocket; Periodontal Attachment Loss; Diabetes Mellitus; Diabetes Mellitus, Type 2; Inflammation
Study type: Interventional

Summary: 
      Objectives: This study aimed to determine the effect of concomitant antimicrobial
      photodynamic therapy (aPTD) on periodontal disease and glycaemic control in patients with
      type 2 diabetes mellitus (T2DM).

      Clinical Relevance: aPTD is a noninvasive adjunctive therapy that can positively influence
      the periodontal treatment outcome.
    

Detailed description: 
      Numerous studies confirm that diabetes mellitus increases the risk of gingivitis and
      periodontitis. However, periodontal disease also impairs glycaemic control in people with
      diabetes mellitus via inflammatory mediators.

      Methods:

      Twenty-four patients with T2DM were enrolled in the study. Periodontal tissue status and
      periodontal disease were assessed by measuring probing pocket depth (PPD), bleeding on
      probing (BOP), clinical attachment loss (CAL), plaque index (PI) and sulcus bleeding index
      (SBI). Glycated haemoglobin A1c (HbA1c) was measured. To determine the presence of the
      following periodontal pathogenic bacteria Aggregatibacter actinomycetemcomitans, Prevotella
      intermedia, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola,
      subgingival plaque samples were taken from two periodontal pockets with the greatest PPD
      using paper tips. Patients were randomly divided into the test and control group. In the test
      group, complete oral disinfection was performed in combination with aPTD. In the control
      group, only complete oral disinfection was performed.
    

Intervention name(s): Conventional Periodontal Treatment (Complete Oral Disinfection); Adjunctive Photodynamic Therapy
Intervention type(s): Procedure; Procedure
Intervention description(s): Oral hygiene instructions followed by complete oral disinfection (removal of hard and soft deposits, scaling and root planing, mouth rinse with 0.2% chlorhexidine twice in one minute, pocket rinse with 0.2% chlorhexidine three times in ten minutes). Ultrasonic (Piezoled, KaVo) and hand instruments (Gracey curettes, Hu-Friedy, USA) were used for this purpose.
For the next 14 days, all patients were asked to rinse their oral cavities twice daily with 0.12% chlorhexidine.; Photodynamic Therapy as adjunctive treatment in pockets with PPD ≥ 5 mm. For this purpose, a Fotona XD -2 diode laser (Fotona, Ljubljana, Slovenia) with a wavelength of 810 nm, a power of 250 mW and the photosensitizing agent indocyanine green at a concentration of 1 mg/ml was used. First, the area to be irradiated was isolated, and the photosensitizing agent was applied to the periodontal pocket. After 60 seconds, the supragingival excess of the photosensitizing agent was removed by gentle rinsing with a saline solution. This was followed by irradiation for ten seconds on each side.
For the next 14 days, all patients were asked to rinse their oral cavities twice daily with 0.12% chlorhexidine.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Test and Control group. All patients received oral hygiene instructions followed by complete oral disinfection (removal of hard and soft deposits, scaling and root planing, mouth rinse with 0.2% chlorhexidine twice in one minute, pocket rinse with 0.2% chlorhexidine three times in ten minutes). Ultrasonic (Piezoled, KaVo) and hand instruments (Gracey curettes, Hu-Friedy, USA) were used for this purpose. Afterwards, the patients were randomly divided into test and control groups. The patients in the test group received aPDT as adjuvant treatment in pockets with PPD ≥ 5 mm.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Type 2 Diabetes Mellitus; Periodontal Disease; Antimicrobial Photodynamic Therapy; Indocyanine Green