Photodynamic Therapy As An Adjunctive To Scaling And Root Planing In Treatment Of Mild To Moderate Periodontitis

Objectives To compare photodynamic therapy (PDT) as an adjunctive treatment of mild to moderate periodontitis with scaling and root planing in patients, and explore a new antimicrobial treatment for periodontitis.Methods This is a split-mouth, randomized controlled clinical trial conducted at our outpatient clinics, between March2011and July2012.Twenty-five patients, Fifteen men and ten women, between29and65years of age (mean age,45.6years), with a clinical diagnosis of mild to moderate periodontitis were selected. Six teeth, three pairs with probing depth of more than4mm and not exceeding6mm plus bleeding on probing at one or more periodontal sites in each patient were selected, The total number of teeth selected in this surgery is one hundred and fifty. On the principle, teeth in different groups in one patient were in different quadrants. All teeth were received systematically supragingival scaling, subgingival scaling and root planing (SRP). Three teeth were randomly assigned to SRP plus PDT using a laser source with a wavelength of660nm associated with26.7mmol/L methylene blue as the photosensitizer in1,3and5weeks after SRP(test group) and the contra-lateral teeth were assigned to SRP only (control group).Probing depth (PD), Bleeding on probing (BOP) and Bleeding Index (BI) were recorded at baseline,5and7weeks after SRP. The color, shape and texture of the gingival were also recorded. The original data of PD, BOP and BI were processed, PD taking the mean, BOP taking the positive rate and BI taking the mean of the overall score. Because the data do not following a normal distribution, non-parametric tests were used to compare the changes of PD, BOP and BI.Results During the photodynamic therapy and after the treatment, patients did not fell any uncomfortable, with no systemic symptoms and local undesirable reactions such as swelling, itching, burning, blisters and ulcers. After photodynamic therapy, gingival swelling was subsided and bleeding was reduced.At the baseline, the median of PD in the experimental group was3.339mm, P25and P75of PD were3.280mm and4.030mm, respectively. In the control group, the median of PD in the experimental group was3.670mm, P25and P75of PD were3.085mm and4.030mm respectively. The difference between the two groups was not statistically significant (P>0.05).5weeks after SRP, PD in the experimental group was reduced to2.720(2.330,3.250) mm, whereas in the control group PD was reduced to2.890(2.665,3.500) mm, there was statistically significant difference between the two groups (P=0.024).7weeks after SRP, PD in the experimental group and the control group was2.610(2.220,3.000) mm and2.780(2.360,3.085) mm, respectively.But the difference between the two groups was not statistically significant (P>0.05). PD of both groups shows better outcomes after the treatment, and the difference was statistically significant (P<0.05).At the baseline, the median of BOP in the experimental group and the control group was0.833, P25and P75of BOP in the two groups were0.639and0.944,0.639and0.917, respectively. The difference between the two groups was not statistically significant (P>0.05).5weeks after SRP, BOP in the experimental group was reduced to0.333(0.111,0.611),whereas in the control group BOP was reduced to0.5000(0.361,0.667), there was statistically significant difference between the two groups (P=0.001).7weeks after SRP, BOP in the experimental group and the control group was0.167(0.056,0.333) and0.333(0.167,0.444), respectively. And the difference between the two groups was statistically significant, too (P=0.002). BOP of both groups shows better outcomes after the treatment, and the difference was statistically significant (P<0.05).At the baseline, the median of BI in the experimental group and the control group was3.0, P25and P75of BI in the two groups were2.585and3.585,2.670and3.500, respectively. The difference between the two groups was not statistically significant (P>0.05).5weeks after SRP, BI in the experimental group was reduced to1.830(1.165,2.250), whereas in the control group BI was reduced to2.170(1.670,2.330), there was statistically significant difference between the two groups (P=0.005).7weeks after SRP, BI in the experimental group and the control group were1.170(0.750,1.500) and1.500(1.000,1.750), respectively. The difference between the two groups was statistically significant (P=0.003). BI of both groups shows better outcomes after the treatment, and the difference was statistically significant (P<0.05).Conclusions Photodynamic therapy have an additional benefit to scaling and root planning when treating patients affected with mild to moderate periodontitis. Multiple PDT applications might further improve the outcome of periodontal therapy.