photodynamik
Die photodynamische Reinigung von manadental basiert auf dem in Forschung und Anwendung etablierten Wirkprinzip der aPDT (antimikrobiellen photodynamischen Therapie). Hierbei werden Plaque bildende Bakterien mit einem Farbstoff (auch Photosensitizer genannt) eingefärbt und anschließend mit Licht geeigneter Wellenlänge bestrahlt. Durch die Bestrahlung wird der Farbstoff aktiviert und die Bakterien eliminiert. Folgend eine Übersicht zur Technologie und Forschungslage.
photodynamik
Die photodynamische Reinigung von manadental basiert auf dem in Forschung und Anwendung etablierten Wirkprinzip der aPDT (antimikrobiellen photodynamischen Therapie). Hierbei werden Plaque bildende Bakterien mit einem Farbstoff (auch Photosensitizer genannt) eingefärbt und anschließend mit Licht geeigneter Wellenlänge bestrahlt. Durch die Bestrahlung wird der Farbstoff aktiviert und die Bakterien eliminiert. Folgend eine Übersicht zur Technologie und Forschungslage.
01 | einleitung
Im Schnitt bleiben zwischen 35-64% Plaque auf Zahnflächen im Mundraum zurück. Diese Restplaque sind Hauptursache für Zahnfleischentzündungen und weitere Zahnfleischerkrankungen von denen bis zu 52% der erwachsenen Bevölkerung in Deutschland betroffen sind. manadental hat den Zweck die Zahnbürste zu komplettieren und mittels der photodynamischen Reinigung, Restplaque und Plaque bildenen Keime zu eliminieren. So nutzt manadental eine bereits etabilierten Technologie aus dem professionellen Umfeld um sie auch für Anwender im häuslichen Bereich zugänglich zu machen.
Die antimikrobielle photodynamische Therapie (aPDT) basiert auf der Anwendung eines Photosensitizers, der von Bakterien aufgenommen wird. Durch Bestrahlung mit Licht in der für den jeweiligen Photosensitizer adäquaten Wellenlänge setzt dieser im lebenden Gewebe in einer photochemischen Reaktion Singulett-Sauerstoff frei, wodurch die Keime selektiv eliminiert werden. Die Anwendung ist oft wiederholbar, mit Resistenzentwicklung ist nicht zu rechnen.
In den letzten Jahren hat sich die Erkenntnis durchgesetzt, dass Störungen des Mikrobioms Ursachen chronischer bzw. gravierender Erkrankungen sein können. Abgesehen von der Gefahr der Resistenzentwicklung macht die Vielfalt der Keime in einem Mikrobiom die Anwendung von antibiotische Mitteln problematisch. Zusätzlich sind Keime in Biofilmen für antibiotische Substanzen, aber auch für Immunzellen schwer erreichbar.
Die aPDT stellt eine nicht-invasive und lokale Methoden dar um Plaque zu reduzieren, und greift somit meist weniger in das Mundmikrobiom ein als ein breit flächenwirksame antibakterielle Mundspülung.
02 | wirkprinzip
Bei der aPDT werden zunächst Erreger mit einem primär nicht-antibakteriellen Photosensitizer in Kontakt gebracht, und nehmen diesen selektiv auf: Er bindet an deren Zellmembranen und passiert diese auch, um an zelluläre Proteine sowie an Erreger-DNA zu binden. Danach wird das Areal photosensitivierter Erreger mit Licht in der für den jeweiligen Photosensitizer adäquaten Wellenlänge bestrahlt. Dadurch entstehen aus dem Photosensitizer Sauerstoffmoleküle, die zur Schädigung von Erregermembranen, Strukturproteinen führen. Dieser Effekt ist bei Bakterien aller Kategorien, inklusive hochresistenter Stämme reproduzierbar, und auch bei Pilzen, Algen, Protozoen, Viruspartikeln und Prionen zu beobachten. aPDT weist damit ein sehr breites Wirkspektrum auf.
Unter der Voraussetzung, dass der Photosensitizer in Biofilme eindringt, ist aPDT auch bei den sonst schwer erreichbaren Erregern in Biofilmen effektiv.
Eine Vielzahl von Photosensitizern die durch unterschiedliche Wellenlängen sichtbaren Lichts aktiviert werden, wurde bisher experimentell und klinisch getestet. Dazu gehören z.B. Methylenblau, Toluidinblau, Indocyaningrün, Malachitgrün, Erythrosin, Bengalrosa, Eosin-Y, die Gruppe der Radachlorine und Curcumin und Riboflavin.
Das wasserlösliche Riboflavin (Vitamin B2) hat im Stoffwechsel als Oxyreduktase eine zentrale Bedeutung und gehört zu den sogenannten „natürlichen“ Photosensitizern. Es weist unter den Photosensitizern die Besonderheit auf, als antimikrobielle Substanz bereits per se das Wachstum verschiedenster Pathogene einschließlich Bakterien, Viren, Pilzen und Parasiten negativ beeinflussen zu können.
03 | anwendungsbereiche
aPDT kann überall dort eingesetzt werden, wo Erreger einerseits mit einem Photosensitizer in Kontakt gebracht, und andererseits mit Licht adäquater Wellenlänge bestrahlt werden können. Haupteinsatzbereiche sind daher Periodontitis, Endodontitis, Mucositis, oberflächliche Wundinfektionen, Keratitis und Endophthalmitis. Dabei sprechen auch die sonst schwer zugänglichen, durch Biofilme hervorgerufenen Infektionen gut auf die Anwendung an.
Die im klinischen Einsatz getesteten Photosensitizer haben bisher bis auf seltene, lokale Reizungen keine unerwünschten Wirkungen gezeigt, sodass die aPDT als sehr sicher gelten darf.
04 | studienlage
In vitro, in vivo und im klinischen Einsatz sowohl in Pilot- als auch in randomisierten Studien wurde aPDT bisher umfangreich getestet.
Neben der Dokumentation des Wirkmechanismus haben in-vitro bzw. präklinische Studien die ausgeprägte, reproduzierbare bakterizide Wirkung der aPDT, das Fehlen von Toxizität für das Gewebe und das Fehlen einer Resistenzentwicklung der Erreger gegenüber aPDT nachgewiesen. Vor allem die gute Wirkung auf Infekte im Rahmen von Biofilmbildung wurde in vitro und in vivo belegt.
Sowohl in der experimentellen als auch in der klinischen Anwendung existiert vor allem auf dem Sektor der Zahnheilkunde eine gute Studienlage. Die Indikationen betreffen Periodontitis, Periimplantitis, Endodontitis und Mucositis, wobei fast durchgängig Standardtherapien mit Standardtherapie plus aPDT verglichen wurden. Letztere ergab bessere Wirkung auf die periodontale Immunantwort, Gewebeintegrität und Erhalt der alveolaren Knochenstruktur. Durch additive aPDT wurde bei Peridontitis die Keimzahl verringert und die Zusammensetzung des Mikrobioms des dentalen Plaque in Richtung günstigeren Spektrums verändert, während „bleeding on probing“ signifikant abnahm. Auch die postoperativen Ergebnisse bei Periimplantitis waren bei additivem Einsatz von aPDT besser als in der Vergleichsgruppe.
Nam Rosema, D E Slot, W H van Palenstein Heldreman, L Wiggelinkhuizen, G A Van der Weijden
Int J Dent Hyg.2016 Feb;14(1):29-41. doi: 10.1111/idh.12115.Epub 2014 Dec 25.
https://pubmed.ncbi.nlm.nih.gov/25545231/
Abstract
Aim:
The primary objective was to determine, based on the available
published evidence, the efficacy of powered toothbrushing following a
brushing exercise and secondary to what magnitude this effect is
dependent on the plaque index score, power supply and mode of action.
Material and methods:
The PubMed-MEDLINE and Cochrane CENTRAL databases were searched
through and up to August 2014 to identify appropriate studies. The
outcome measurement was the weighted mean (WM) percentage plaque score
reduction of a full-mouth assessment following subject brushing.
Results:
The search yielded 2420 titles and abstracts. Ultimately, 58
articles with 146 brushing exercises as separate legs were selected. The
overall effect of a powered brushing exercise provides a 46% WM plaque
score reduction. One hundred and six experiments provided data as
assessed according to the Quigley and Hein plaque index. The WM
reduction from baseline in plaque scores was 36%. A WM plaque score
reduction of 65% was observed in 39 experiments using the Navy plaque
index. Subanalysis on power supply and mode of action showed WM plaque
score reductions ranging from 33% up to 71% depending on plaque index
score.
Conclusion:
The efficacy in plaque removal following a brushing exercise using a powered toothbrush provides a WM plaque score reduction of 46% on
average, with a range of 36-65% dependent on the index scale to score
plaque. The available evidence indicates that the power supply
(rechargeable or replaceable battery), mode of action, as well as
brushing duration and type of instructions are factors which contribute
to the variation in the observed efficacy.
Keywords:
brushing exercise; dental plaque; powered toothbrush; systematic review.
Leandro Chambrone , Hom-Lay Wang , Georgios E Romanos
J Periodontol 2018 Jul;89(7):783-803. doi: 10.1902/jop.2017.170172
https://pubmed.ncbi.nlm.nih.gov/30133749/
Background:
This systematic review evaluates the efficacy of antimicrobial photodynamic therapy (aPDT), as an adjunct to non-surgical or surgical therapy, on clinical and patient-centered outcomes in patients with periodontitis or peri-implantitis.
Methods:
Randomized controlled trials (RCTs) with a follow-up duration ≥ 3 months that evaluated mechanical root/implant surface debridement (i.e., scaling and root planing [SRP] or implant surface scaling [ISS]) versus SRP or ISS plus aPDT for the treatment of adult patients (≥ 18 years old) with moderate-to-severe chronic (CP)/aggressive periodontitis (AgP) or peri-implantitis, respectively, were considered eligible for inclusion. The MEDLINE, EMBASE, and CENTRAL databases were searched for articles published up to and including March 2017. Random-effects meta-analyses were used throughout the review using continuous data (i.e., mean changes from baseline), and pooled estimates were expressed as weighted mean differences with their associated 95% confidence intervals. Additionally, summaries are presented of the included RCTs, critical remarks of the literature, and evidence quality rating/strength of recommendation of laser procedures.
Results:
Of 729 potentially eligible articles, 28 papers (26 studies) were included in the review. Individual study outcomes and four sets of meta-analysis showed potential statistical significant benefit of aPDT in improving clinical attachment level (CAL) (non-surgical treatment of AgP) and probing depth (PD) (non-surgical treatment of AgP and CP). However, the comparative differences in clinical outcomes were modest (< 1 mm), and the level of certainty for different therapies was considered low-to-moderate (i.e., more information would be necessary to allow for a reliable and definitive estimation of effect/magnitude of therapies on health outcomes). Overall, most of the strengths of clinical recommendations of aPDT were guided by the expert opinion.
Conclusions:
aPDT may provide similar clinical improvements in PD and CAL when compared with conventional periodontal therapy for both periodontitis and peri-implantitis patients. The restricted base of evidence for some treatment approaches and conditions precludes additional conclusions.
Keywords:
dental scaling; evidence-based dentistry; lasers; periodontitis; photochemotherapy; surgical procedures, operative.
Evelias Yan , Germain Kwek , Ng Shuang Qing , Shonya Lingesh , Bengang Xing .
Chempluschem 2023 Mar;88(3):e202300009. doi: 10.1002/cplu.202300009
https://pubmed.ncbi.nlm.nih.gov/36853914/
Abstract
The emergence of multi-drug resistant bacteria strains has been an uphill battle in modern healthcare worldwide, due to the increasing difficulty of killing them. The evolving pathogenicity of bacteria has led to researchers searching for more effective antimicrobial therapeutics to successfully eliminate them without undesirable consequences to the human body. In recent years, antimicrobial photodynamic therapy (APDT), an obsolete technique for cancer treatments, has been reported to eradicate bacteria and biofilm-related infections. The principle of antimicrobial photodynamic therapy solely relies on the photosensitizers (PSs) generating reactive oxygen species, in the presence of oxygen and light, to destroy pathogens. Thus, it can target a broad spectrum of microorganisms, owing to the indirect interaction between PSs and the bacteria, resulting in the less likelihood for the development of drug resistant bacteria strains. This review will focus on the recent progress of APDT in the last five years and some future perspectives of APDT. The mechanism of APDT against bacteria and biofilms, various PSs used for APDT, and some common multidrug-resistant bacteria strains will be briefly introduced. The reported in vivo applications of APDT in the several types of bacterial infections that includes periodontitis, wound infections, keratitis, endophthalmitis and tuberculosis in the last five years will be summarized in detail.
Keywords:
antibiotics; bacteria; multidrug resistance; photodynamic therapy; photosensitizers.
Sandile Phinda Songca , Yaw Adjei
Int J Mol Sci 2022 Mar 16;23(6):3209. doi: 10.3390/ijms23063209
https://pubmed.ncbi.nlm.nih.gov/35328629/
Abstract
Antimicrobial photodynamic therapy and.allied photodynamic antimicrobial chemotherapy have shown remarkable activity against bacterial pathogens in both planktonic and biofilm forms. There has been little or no resistance development against antimicrobial photodynamic therapy. Furthermore, recent developments in therapies that involve antimicrobial photodynamic therapy in combination with photothermal hyperthermia therapy, magnetic hyperthermia therapy, antibiotic chemotherapy and cold atmospheric pressure plasma therapy have shown additive and synergistic enhancement of its efficacy. This paper reviews applications of antimicrobial photodynamic therapy and non-invasive combination therapies often used with it, including sonodynamic therapy and nanozyme enhanced photodynamic therapy. The antimicrobial and antibiofilm mechanisms are discussed. This review proposes that these technologies have a great potential to overcome the bacterial resistance associated with bacterial biofilm formation.
Keywords:
antibiotic chemotherapy; antimicrobial photodynamic therapy; biofilm; cold atmospheric pressure plasma; extracellular polymeric substance; magnetic hyperthermia therapy; nanozyme enhanced photodynamic therapy; photothermal hyperthermia therapy; planktonic bacteria; sonodynamic therapy.
Dorothee Schär , Christoph A Ramseier , Sigrun Eick , Gérald Mettraux , Giovanni E Salvi , Anton Sculean
Photodiagnosis Photodyn Ther 2020 Dec:32:101971. doi: 10.1016/j.pdpdt.2020.101971.
https://pubmed.ncbi.nlm.nih.gov/32835882/
Abstract
Background:
Recent data from preclinical studies and case series suggest that transgingival irradiation with diode lasers may represent a novel modality for antimicrobial photodynamic therapy (aPDT). However, at present, there is lack of data from controlled clinical studies on the use of transgingival antimicrobial photodynamic therapy (tg-aPDT) in the treatment of periodontitis.
Objective:
To evaluate the clinical effects of tg-aPDT used in conjunction with nonsurgical mechanical instrumentation during supportive periodontal therapy (SPT).
Materials and methods:
Forty stage II and III periodontitis patients enrolled in SPT were randomly assigned to two groups of equal size. At baseline, study sites had to show sites with pocket probing depth (PPD) of ≥ 5 mm and Bleeding on Probing (BOP). Full mouth and site-specific Plaque-Index scores (PI), BOP, PPD, and Clinical Attachment Level (CAL) were recorded at baseline (BL), three months (3 M), and 6 months (6 M), respectively. The primary outcome variable was the change in the number of sites with BOP. Treatment was performed under local anaesthesia after random allocation to one of the following groups 1) Subgingival scaling and root planing (SRP) + tg-aPDT (test) or 2) SRP alone (control).
Results:
Thirty-nine patients completed the study. Full mouth PI and BOP improved over six month, however without statistically significant difference between the groups. At 6 M, BOP-levels were statistically significantly lower in test sites (25.0 %) compared to the control sites (65.0 %), (p < 0.025). PPD improved in both groups with comparable mean values at 3 M (PPD test: 5.21 ± 0.92 mm; PPD control: 4.45 ± 1.36 mm) and 6 M (PPD test: 5.11 ± 1.10 mm; PPD control: 4.35 ± 1.14 mm). Additionally, CAL slightly improved in both groups with comparable mean values at 3 M (CAL test: 6.79 ± 1.72 mm; CAL control: 5.30 ± 2.43 mm) and 6 M (CAL test: 6.26 ± 1.70 mm; CAL control: 5.50 ± 2.33 mm).
Conclusions:
Within its limits, the present results appear to indicate that the use of tg-aPDT adjunctive to SRP may represent a new modality for controlling inflammation and further bleeding in residual periodontal pockets.
Keywords:
Non-surgical periodontal treatment; Scaling and root planing; Supportive periodontal therapy; Transgingival antibacterial photodynamic therapy; tg-aPDT.
Tianyuan Zhao , Jungyul Song , Yuzhuo Ping, Meihua Li
Comput Math Methods Med 2022 May 12:2022:3547398. doi: 10.1155/2022/3547398.
https://pubmed.ncbi.nlm.nih.gov/35602342/
Abstract
Background:
This literature review evaluates the mechanisms and efficacy of different types of antimicrobial photodynamic therapy (aPDT) for treating peri-implantitis by reviewing existing experimental studies to provide guidance for the clinical application of antibacterial photodynamic therapy (aPDT) in oral implants.
Materials and methods:
From February 2001 to February 2021, we have collected 152 randomized controlled trials of aPDT for peri-implantitis by searching the experimental studies and clinical trials published in PubMed, Embase, Web of Science, and Google Scholar databases via online search. After screening the retrieved literature, we finally selected 10 statistically significant literature for evaluation and review.
Results:
Compared with the traditional nonsurgical treatment of peri-implantitis, the aPDT was superior to the traditional mechanical irrigation treatment group in terms of periodontal indexes PD, BOP, PLI, and postoperative effect, and the difference was statistically significant (P < 0.05). Furthermore, the combination of the aPDT and other treatments shows the synergistic antibacterial effect, signifying better clinical effect in many aspects (P < 0.05). In these 10 papers, by comparing the probe depth (PD), bleeding on probing (BOP), synosteosis, and periodontal pathogenic bacteria detection, etc., obtained after treating peri-implantitis by application of the antimicrobial photodynamic therapy, and using the SPSS data analysis software for statistical data processing, we found that the antimicrobial photodynamic therapy combined with other periodontal treatments has a more prominent postoperative effect. Meanwhile, the antibacterial photodynamic therapy with targeted action of photosensitizer has strong specificity to some bacteria, while the synthetic photosensitize for antibacterial photodynamic therapy can show good inactivation effect on broad-spectrum periodontal anaerobes without side effect.
Conclusion:
The experimental studies and clinical data of antibacterial photodynamic therapy for treating peri-implantitis show a good postoperative treatment effect. In addition, it did not develop resistance due to the use of antibiotic drugs. Owing to multiple advantages from combining antibacterial photodynamic therapy and other treatments, it is applicable for clinical treatment.
Yuxin Zhao , Rui Pu , Yinjie Qian , Jue Shi, Misi Si
Photodiagnosis Photodyn Ther 2021 Jun:34:102231. doi: 10.1016/j.pdpdt.2021.102231
https://pubmed.ncbi.nlm.nih.gov/33621702/
Abstract
Background:
Clinical efficacy of antimicrobial photodynamic therapy (aPDT) as compared to antibiotics in periodontitis and peri-implantitis has been tested in several clinical trials. Yet controversial results were reported. The aim of the present study was to answer the question: "Will adjunctive antimicrobial photodynamic therapy be more effective than antibiotics agent in the treatment of periodontitis and peri-implantitis?".
Methods:
Publications compared outcomes between aPDT and antibiotics in adult patients with periodontitis or peri-implantitis, containing more than 3-month follow-up duration, were involved in the systematic review and meta-analysis. PubMed, EMBASE and Cochrane Central were searched until December of 2020. Clinical parameters including pocket probing depth (PPD), clinical attachment level (CAL), and bleeding on probing (BOP) were evaluated. The risk of bias was assessed by Cochrane Collaboration Tool. Weighted mean differences (WMD), 95 % confidence interval(CI) and heterogeneity were estimated by Review Manager software.
Results:
10 trials in periodontitis and 5 trials in peri-implantitis were included. Meta-analysis outcomes revealed equal clinical evidence for aPDT and antibiotics in periodontitis and peri-implantitis. In addition, aPDT significantly reduced the red complex in both diseases. However, owing to the heterogeneity of protocols in articles and the limited number of studies, the comparative conclusion remained unconfirmed.
Conclusion:
aPDT can be considered as an alternative to antibiotics in the treatment of peri-implantitis and periodontitis. Given that high heterogeneity in outcome was found in this review, future long-term clinical trials with standard aPDT and antibiotic treatment should be tested to arrive at a firm conclusion
Keywords:
Antibiotics; Antimicrobial photodynamic therapy; Meta-analysis; Peri-implantitis; Periodontitis; Systematic review.
Aleksandra Warakomska, Jakub Fiegler-Rudol, Magdalena Kubizna, Dariusz Skaba, Rafał Wiench.
Pharmaceutics 2025 Mar 30;17(4):443. doi: 10.3390/pharmaceutics17040443
https://pubmed.ncbi.nlm.nih.gov/40284438/
Abstract
Background:
Peri-implantitis, an inflammatory condition leading to progressive bone loss around dental implants, represents a significant challenge in modern implant dentistry. Conventional mechanical debridement and adjunctive antibiotics or antiseptics often fail to fully eradicate complex biofilms and may promote antibiotic resistance. Photodynamic therapy (PDT) mediated by natural photosensitizers (e.g., curcumin, riboflavin, and 5-aminolevulinic acid) has emerged as a potential adjunctive strategy for peri-implantitis management due to its targeted antimicrobial and anti-inflammatory effects.
Objectives:
This systematic review aimed to evaluate the antimicrobial efficacy, clinical outcomes, and safety of PDT mediated by natural photosensitizers in the treatment of peri-implantitis and to identify optimal protocols regarding photosensitizer concentrations, light source parameters, and application techniques.
Methods:
Following PRISMA 2020 guidelines, databases (PubMed/Medline, Embase, Scopus, and Cochrane Library) were searched from 1 January 2015 to 3 January 2025 for English-language publications. Studies assessing naturally based PDT interventions for peri-implantitis or in vitro biofilms from diseased implant surfaces were included. Quality assessment used the Revised Cochrane Risk of Bias tool (RoB 2) for randomized controlled trials and a tailored nine-item framework for in vitro studies. Eleven studies met the inclusion criteria.
Results:
Despite heterogeneity in methodologies, especially regarding light wavelengths, energy densities, and photosensitizer formulations, most studies reported notable reductions in bacterial viability, biofilm mass, and clinical indices (probing depth and bleeding on probing). Curcumin and riboflavin frequently demonstrated comparable antimicrobial efficacy to standard disinfectants, while 5-aminolevulinic acid (5-ALA)-based PDT also showed promising clinical and microbiological improvements. However, complete biofilm eradication was rarely achieved.
Conclusions:
Natural-photosensitizer-based PDT appears to be a valuable adjunct to mechanical debridement for peri-implantitis, enhancing microbial control and clinical outcomes. Standardization of PDT protocols and further well-designed clinical trials with extended follow-up periods are warranted to confirm long-term efficacy and inform evidence-based guidelines.
Keywords:
5-ALA; antimicrobial therapy; biofilm; curcumin; dental implants; peri-implantitis; photodynamic therapy; riboflavin.
Hiba F Kattan.
Photodiagnosis Photodyn Ther 2023 Dec:44:103697.doi: 10.1016/j.pdpdt.2023.103697
https://pubmed.ncbi.nlm.nih.gov/37473792/
Abstract
Background:
Optimal endodontic disinfection by means of conventional root canal treatment of primary teeth remains a challenge. Recently, antimicrobial photodynamic therapy (aPDT) has been proposed as an adjunct to conventional endodontic treatment for microbial disinfection. The purpose of this review is to critically appraise and synthesize the currently-available evidence about the antimicrobial efficacy of aPDT (antimicrobial photodynamic therapy) when used as an adjunct to traditional root canal therapy.
Materials and methods:
The focused question was ''In primary teeth needing root canal treatment (participants), is adjunct aPDT (intervention) more effective in disinfecting coronal and radicular dentine (outcomes) than root canal treatment alone (control)?'. The electronic research databases PubMED/Medline, ISI Web of Knowledge, Embase and CENTRAL (Cochrane Central Register of Controlled Trials) using relevant keyword phrases including 'antimicrobial photodynamic therapy', 'primary teeth', 'deciduous teeth', and 'endodontic treatment'. Original studies that described endodontic treatment of primary teeth or dentine using aPDT in comparison to conventional endodontic treatment were included. Case reports, reviews and other non-comparative studies were excluded. The literature search and quality assessment were carried out by two reviewers independently.
Results:
Ultimately, 9 studies were included in this review. Overall, majority of the studies concluded that adjunct aPDT improves the antimicrobial efficacy of conventional root canal therapy. However, several sources of bias were found in the studies.
Conclusion: Within the limitations of the studies, it is concluded that aPDT is a suitable adjunct to improve the disinfection of conventional root canal treatment. However, future studies should focus on the clinical outcomes, in relation to the reduction of microbial counts to ascertain the efficacy of aPDT in disinfection of primary dentine.
Keywords:
Coronal dentin; Photodynamic therapy; Primary dentin; Radicular dentin; Review; Root canal.
Pierre Geraldo Braz da Silva-Junior, Lucas Guimarães Abreu, Fernando Oliveira Costa, Luís Otávio Miranda Cota, Rafael Paschoal Esteves-Lima.
Photodiagnosis Photodyn Ther 2023 Jun:42:103573. doi: 10.1016/j.pdpdt.2023.103573.
https://pubmed.ncbi.nlm.nih.gov/37062511/
Abstract
Background:
The purpose of the present systematic review and meta-analysis was to assess the impact of antimicrobial photodynamic therapy adjunct to non-surgical periodontal treatment on individuals with type 2 diabetes mellitus.
Methods:
The Preferred Reporting Items for Systematic Reviews and Meta-analyses statement was followed. Searches were carried out in six databases without restriction regarding publication year. Studies comparing periodontal clinical parameters among individuals submitted to non-surgical periodontal therapy associated with antimicrobial photodynamic therapy and a control group of individuals submitted to only non-surgical periodontal treatment were included. Study selection, data extraction, and risk of bias assessment (RoB 2.0) were performed by two review authors. Meta-analysis was performed. Mean difference (MD) and 95% confidence interval (CI) were provided.
Results:
Two hundred and five studies were identified and 11 studies were included. The meta-analysis demonstrated that antimicrobial photodynamic therapy adjunctive to periodontal therapy, in individuals with diabetes, resulted in a greater reduction of bleeding on probing at 6 months and in probing depth at 3 and 6 months in comparison to periodontal treatment alone (p<0.05). The included studies exhibited low risk of bias.
Conclusion:
Antimicrobial photodynamic therapy adjunct to periodontal therapy contributes to the improvement of periodontal clinical parameter bleeding on probing and probing depth in individuals with type 2 diabetes mellitus.
Keywords:
Diabetes mellitus; Periodontal diseases; Periodontitis; Photodynamic therapy; Type 2.
Samaneh Bourbour , Atieh Darbandi, Narjess Bostanghadiri, Roya Ghanavati, Behrouz Taheri, Abbas Bahador.
Curr Pharm Biotechnol 2024;25(10):1209-1229. doi: 10.2174/138920102466623072010451
https://pubmed.ncbi.nlm.nih.gov/37475551/
Abstract
Antimicrobial photodynamic therapy or aPDT is an alternative therapeutic approach in which lasers and different photosensitizing agents are used to eradicate periodontopathic bacteria in periodontitis. Periodontitis is a localized infectious disease caused by periodontopathic bacteria and can destroy bones and tissues surrounding and supporting the teeth. The aPDT system has been shown by in vitro studies to have high bactericidal efficacy. It was demonstrated that aPDT has low local toxicity, can speed up dental therapy, and is cost-effective. Several photosensitizers (PSs) are available for each type of light source which did not induce any damage to the patient and are safe. In recent years, significant advances have been made in aPDT as a non-invasive treatment method, especially in treating infections and cancers. Besides, aPDT can be perfectly combined with other treatments. Hence, this survey focused on the effectiveness and mechanism of aPDT of periodontitis by using lasers and the most frequently used antimicrobial PSs such as methylene blue (MB), toluidine blue ortho (TBO), indocyanine green (ICG), malachite green (MG) (Triarylmethanes), erythrosine dyes (ERY) (Xanthenes dyes), rose bengal (RB) (Xanthenes dyes), eosin-Y (Xanthenes dyes), radachlorin group and curcumin. The aPDT with these PSs can reduce pathogenic bacterial loads in periodontitis. Therefore, it is clear that there is a bright future for using aPDT to fight microorganisms causing periodontitis.
Keywords:
Periodontitis; antimicrobial photosensitizers; bacterial infections; methylene blue; photodynamic therapy; toluidine blue ortho..
Sijia Liu, Wanqing Zhao, Yusen Qie, Na Liu, Qing Liu.
Int J Med Sci 2025 May 28;22(11):2653-2662. doi: 10.7150/ijms.107543
https://pubmed.ncbi.nlm.nih.gov/37475551/
Abstract
Grade C periodontitis in young individuals is characterized by its early onset and rapid progression, resulting in swift periodontal tissue destruction in systemically healthy individuals. The application of laser technology in periodontal therapy has gradually increased in recent years. Laser therapy offers several advantages over traditional antibiotics, such as reduced patient discomfort, minimized postoperative edema, and a lower risk of drug-resistant strains. Recent studies suggest that laser-assisted treatments can significantly augment the clinical efficacy in managing grade C periodontitis. However, available evidence has not drawn distinct conclusions. This review aims to present the research progress in laser and antibacterial photodynamic therapy as the adjuvant treatment of grade C periodontitis in young individuals over the past decade, offering references for clinical practice.
Keywords:
aggressive periodontitis; antibacterial photodynamic therapy (APDT); laser; therapy.
Jungyul Song, Zhiqin Gao, Meihua Li.
Optics & Laser Technology Volume 149, May 2022, 107808
https://pubmed.ncbi.nlm.nih.gov/29177555/
Abstract
Studies evaluating the efficacy of adjunctive photodynamic therapy (PDT) for chronic periodontitis have reported conflicting results. The Web of Science, Cochrane Library, Pubmed, Embase, China National Knowledge Internet, Wanfang Data, VIP, and Chinese Biomedical Literature Database were searched for randomized controlled trials that compared scaling and root planing (SRP) with and without PDT for chronic periodontitis. Studies published before November 4, 2020 were included in the pooled analyses performed using the Review Manager 5.3 and Stata 12.0 software. A total of 18 RCTs involving 750 patients with periodontitis were identified. The pooled analysis showed that SRP with PDT had significantly different probing depth (PD) at third month [standardized mean difference (SMD), 0.22 mm; 95% CI, 0.07–0.37; P = 0.004]. However, there was no significant difference in the PD at sixth month (SMD, 0.12; 95% CI, −0.10–0.33; P = 0.280).
In addition, we found a significant difference in the clinical attachment level at third month (SMD, 0.24; 95% CI, 0.08–0.39; P = 0.003), whereas no significant difference was found in the clinical attachment level at sixth month (SMD, 0.18; 95% CI, −0.03–0.40; P = 0.090). In terms of the bleeding on probing, SRP with PDT revealed to be significantly better compared to SRP along at third month of follow-up (SMD, 0.77; 95% CI, 0.42–1.13; P < 0.001), but not at sixth month (SMD, 5.11; 95% CI, −2.50–12.72; P = 0.190). Adjunctive PDT improved the clinical efficacy in terms of the PD, clinical attachment level, and bleeding on probing at third month of follow-up, but not at sixth month.
Keywords
Photodynamic therapy, Chronic periodontitis, Periodontal non-surgical treatment,
Meta-analysis
Kelly R V Villafuerte, Cristhiam Jesus H Martinez, Luiz H Palucci Vieira, Atila V Nobre.
Medicina (Kaunas) 2023 Mar 30;59(4):684. doi: 10.3390/medicina59040684.
https://pubmed.ncbi.nlm.nih.gov/37109642/
Abstract
The objective of this study was to analyze evidence of the clinical and microbiological benefits of antimicrobial photodynamic therapy (aPDT) adjunctive to scaling and root planing (SRP) in smokers with periodontitis. Randomized clinical trials (RCTs) were included, through an electronic search in PubMed/MEDLINE, LILACS, Web of Science, and the Cochrane Library for articles published in English until December 2022. The quality of the studies was assessed using the JADAD scale and the risk of bias was estimated using the Cochrane Collaboration assessment tool. Of the 175 relevant articles, eight RCTs were included. Of these, seven reported clinical results and five microbiological results, with a follow-up time of 3-6 months. A meta-analysis was performed for the probing depth (PD) reduction and clinical attachment level (CAL) gain at 3 and 6 months. The weighted mean differences (WMDs) and 95% confidence intervals (CIs) were counted for the PD and CAL. The overall effect for the PD reduction at 3 and 6 months (WMD = -0.80, 95% CI = -1.44 to -0.17, p = 0.01; WMD = -1.35, 95% CI = -2.23 to -0.46, p = 0.003) was in favor of aPDT. The CAL gain (WMD = 0.79, 95% CI = -1.24 to -0.35, p = 0.0005) was statistically significant at 6 months, in favor of aPDT. In these RCTs, aPDT was unable to demonstrate efficacy in reducing the microbial species associated with periodontitis. aPDT as an adjuvant to SRP improves the PD reduction and CAL gain more effectively than only SRP. RCTs are needed to establish standardized protocols with longer follow-up times in order to provide more results on aPDT adjunctive to SRP in smokers with periodontitis.
Keywords: periodontitis; photodynamic therapy; smokers; ּscaling root planning.
Caetano P Sabino, Martha S Ribeiro, Mark Wainwright, Carolina Dos Anjos, Fábio P Sellera, Milena Dropa, Nathalia B Nunes, Guilherme T P Brancini, Gilberto U L Braga, Victor E Arana-Chavez, Raul O Freitas, Nilton Lincopan, Maurício S Baptista.
Photochem Photobiol 2023 Mar;99(2):742-750. doi: 10.1111/php.13685.
https://pubmed.ncbi.nlm.nih.gov/35913428/
Abstract
The unbridled dissemination of multidrug-resistant pathogens is a major threat to global health and urgently demands novel therapeutic alternatives. Antimicrobial photodynamic therapy (aPDT) has been developed as a promising approach to treat localized infections regardless of drug resistance profile or taxonomy. Even though this technique has been known for more than a century, discussions and speculations regarding the biochemical mechanisms of microbial inactivation have never reached a consensus on what is the primary cause of cell death. Since photochemically generated oxidants promote ubiquitous reactions with various biomolecules, researchers simply assumed that all cellular structures are equally damaged. In this study, biochemical, molecular, biological and advanced microscopy techniques were employed to investigate whether protein, membrane or DNA damage correlates better with dose-dependent microbial inactivation kinetics. We showed that although mild membrane permeabilization and late DNA damage occur, no correlation with inactivation kinetics was found. On the other hand, protein degradation was analyzed by three different methods and showed a dose-dependent trend that matches microbial inactivation kinetics. Our results provide a deeper mechanistic understanding of aPDT that can guide the scientific community toward the development of optimized photosensitizing drugs and also rationally propose synergistic combinations with antimicrobial chemotherapy.
Seyedeh Sara Aghili, Alireza Jahangirnia, Mostafa Alam, Asal Bagherzadeh Oskouei Mohsen Golkar , Ashkan Badkoobeh, Kamyar Abbasi, Meysam Mohammadikhah, Shahryar Karami, Reza Sayyad Soufdoost, Reza Abdollahi Namanloo, Sahar Talebi, Samira Amookhteh, Maryam Hemmat, Sima Sadeghi.
J Basic Microbiol 2023 Dec;63(12):1319-1347. doi: 10.1002/jobm.202300400
https://pubmed.ncbi.nlm.nih.gov/35913428/
Abstract
Several resistance mechanisms are involved in dental caries, including oral biofilms. An accumulation of bacteria on the surface of teeth is called plaque. Periodontitis and gingivitis are caused by dental plaque. In this review article, we aimed to review the studies associated with the application of photodynamic therapy (PDT) to prevent and treat various microbial biofilm-caused oral diseases in recent decades. There are several studies published in PubMed that have described antimicrobial photodynamic therapy (APDT) effects on microorganisms. Several in vitro and in vivo studies have demonstrated the potential of APDT for treating endodontic, periodontal, and mucosal infections caused by bacteria as biofilms. Reactive oxygen species (ROS) are activated in the presence of oxygen by integrating a nontoxic photosensitizer (PS) with appropriate wavelength visible light. By causing irreversible damage to microorganisms, ROS induces some biological and photochemical events. Testing several wavelengths has been conducted to identify potential PS for APDT. A standard protocol is not yet available, and the current review summarizes findings from dental studies on APDT.
Keywords:
antimicrobial; caries; oral biofilm; photodynamic; photosensitizer.
Sara Brinar, Aleš Skvarča, Boris Gašpirc, Rok Schara.
Clin Oral Investig 2023 Oct;27(10):6235-6244. doi: 10.1007/s00784-023-05239-0.
https://pubmed.ncbi.nlm.nih.gov/37672083/
Abstract
Objectives:
This study is aimed at determining the effect of concomitant antimicrobial photodynamic therapy (aPTD) on periodontal disease and glycaemic control in patients with type 2 diabetes mellitus (T2DM).
Materials and methods:
Twenty-four patients with T2DM were enrolled in the study. Periodontal clinical parameters were assessed by measuring probing pocket depth (PPD), clinical attachment loss (CAL), gingival recession (GR), full-mouth bleeding score (FMBS), full-mouth plaque score (FMPS), and full-mouth sulcus bleeding score (FMSBS). 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 per jaw with the greatest PPD using paper tips. Patients were randomly divided into the test and control group. In the test group, full-mouth disinfection was performed in combination with aPTD. In the control group, only full-mouth disinfection was performed.
Results:
The results showed an improvement in periodontal clinical parameters in both groups. The difference between the groups in favour of the test group was statistically significant for BOP. The HbA1c level decreased in both groups. The difference was not statistically significant. The results of the microbiological analysis suggest that the presence of periodontal pathogenic bacteria is lower with additional antimicrobial photodynamic therapy with statistically significant difference for T. forsythia.
Conclusions:
Additional aPDT causes a significant reduction in BoP in the proportion of positive sites for periodontal pathogens.
Trial registration:
ClinicalTrials.gov ID: NCT05816941.
Clinical relevance:
aPTD is a noninvasive adjunctive therapy that can positively influence the periodontal treatment outcome.
Keywords:
Antimicrobial photodynamic therapy; Indocyanine green; Periodontal disease; Type 2 diabetes mellitus.
Min Nie, Peipei Zhang, Janak Lal Pathak, Xiaoyu Wang, Yafei Wu, Jingmei Yang, Yuqin Shen.
Photodermatol Photoimmunol Photomed 2024 Jan;40(1):e12946. doi: 10.1111/phpp.12946.
https://pubmed.ncbi.nlm.nih.gov/38288767/
Abstract
Background:
Periodontitis, a chronic infectious disease, is primarily caused by a dysbiotic microbiome, leading to the destruction of tooth-supporting tissues and tooth loss. Photodynamic therapy (PDT), which combines excitation light with photosensitizers (PS) and oxygen to produce antibacterial reactive oxygen species, is emerging as a promising adjuvant treatment for periodontitis.
Methods:
This review focuses on studies examining the antibacterial effects of PDT against periodontal pathogens. It also explores the impact of PDT on various aspects of periodontal health, including periodontal immune cells, human gingival fibroblasts, gingival collagen, inflammatory mediators, cytokines in the periodontium, vascular oxidative stress, vascular behavior, and alveolar bone health. Clinical trials assessing the types of PSs and light sources used in PDT, as well as its effects on clinical and immune factors in gingival sulcus fluid and the bacterial composition of dental plaque, are discussed.
Results:
The findings indicate that PDT is effective in reducing periodontal pathogens and improving markers of periodontal health. It has shown positive impacts on periodontal immune response, tissue integrity, and alveolar bone preservation. Clinical trials have demonstrated improvements in periodontal health and alterations in the microbial composition of dental plaque when PDT is used alongside conventional treatments.
Conclusions:
PDT offers a promising adjunctive treatment for periodontitis, with benefits in bacterial reduction, tissue healing, and immune modulation. This article highlights the potential of PDT in periodontal therapy and emphasizes the need for further research to refine its clinical application and efficacy.
Keywords:
periodontitis; photodynamic therapy; photosensitizers.
Fabian Cieplik, Dongmei Deng, Wim Crielaard, Wolfgang Buchalla, Elmar Hellwig, Ali Al-Ahmad, Tim Maisch.
Crit Rev Microbiol 2018 Sep;44(5):571-589. doi: 10.1080/1040841X.2018.1467876.
https://pubmed.ncbi.nlm.nih.gov/29749263/
Abstract
Considering increasing number of pathogens resistant towards commonly used antibiotics as well as antiseptics, there is a pressing need for antimicrobial approaches that are capable of inactivating pathogens efficiently without the risk of inducing resistances. In this regard, an alternative approach is the antimicrobial photodynamic therapy (aPDT). The antimicrobial effect of aPDT is based on the principle that visible light activates a per se non-toxic molecule, the so-called photosensitizer (PS), resulting in generation of reactive oxygen species that kill bacteria unselectively via an oxidative burst. During the last 10-20 years, there has been extensive in vitro research on novel PS as well as light sources, which is now to be translated into clinics. In this review, we aim to provide an overview about the history of aPDT, its fundamental photochemical and photophysical mechanisms as well as photosensitizers and light sources that are currently applied for aPDT in vitro. Furthermore, the potential of resistances towards aPDT is extensively discussed and implications for proper comparison of in vitro studies regarding aPDT as well as for potential application fields in clinical practice are given. Overall, this review shall provide an outlook on future research directions needed for successful translation of promising in vitro results in aPDT towards clinical practice.
Keywords:
Antimicrobial photodynamic therapy; aPDT; antimicrobial resistance; photodynamic.
Ali Shahi Ardakani, Stefano Benedicenti, Luca Solimei, Sima Shahabi, Shima Afrasiabi.
Pharmaceuticals (Basel) 2024 Sep 18;17(9):1232. doi: 10.3390/ph17091232
https://pubmed.ncbi.nlm.nih.gov/39338394/
Abstract
Objectives:
The aim of this study is to investigate the antimicrobial efficacy of antimicrobial photodynamic therapy (PDT) using natural photosensitizers (curcumin, riboflavin, and phycocyanin) and light-emitting diode (LED) irradiation against multispecies biofilms in an acrylic denture base model.
Materials and methods:
Forty-five acrylic specimens were fabricated using heat-curing acrylic resin. The specimens were then infected with a mixed culture of bacterial and fungal species (including Streptococcus mutans, Streptococcus sanguinis, Candida albicans, and Candida glabrata) for 4 days. The acrylic discs were divided into nine groups, with each group containing five discs: control, 0.2% chlorhexidine, 5.25% sodium hypochlorite, curcumin, riboflavin, phycocyanin alone or along with LED. After treatment, the number of colony-forming units (CFUs) per milliliter was counted. In addition, the extent of biofilm degradation was assessed using the crystal violet staining method and scanning electron microscopy.
Results:
All experimental groups exhibited a significant reduction in colony numbers for both bacterial and fungal species compared to the control (p < 0.001). The PDT groups exhibited a statistically significant reduction in colony counts for both bacteria and fungi compared to the photosensitizer-only groups.
Conclusions:
The results of this in vitro study show that PDT with natural photosensitizers and LED devices can effectively reduce the viability and eradicate the biofilm of microorganisms responsible for causing denture infections.
Keywords:
LED; curcumin; disinfection; multispecies biofilms; natural products; photochemotherapy; phycocyanin; riboflavin.