title: Photodynamic therapy during supportive periodontal care: clinical, microbiologic, immunoinflammatory, and patient-centered performance in a split-mouth randomized clinical trial.
abstract: BACKGROUND
  This study investigates the effect of photodynamic therapy (PDT) as monotherapy during supportive periodontal therapy.
  
  
  METHODS
  A split-mouth, randomized controlled trial was conducted in patients with chronic periodontitis (N = 22) presenting at least three residual pockets (probing depth [PD] ≥5 mm with bleeding on probing [BOP]). The selected sites randomly received the following: 1) PDT; 2) photosensitizer (PS); or 3) scaling and root planing (SRP). At baseline and 3 and 6 months, clinical, microbiologic (real-time polymerase chain reaction analyses), cytokine pattern (multiplexed bead immunoassay), and patient-centered (regarding morbidity) evaluations were performed.
  
  
  RESULTS
  All therapies promoted similar improvements in clinical parameters throughout the study (P <0.05), except that BOP was not reduced in the PS protocol (P >0.05). Lower levels of Aggregatibacter actinomycetemcomitans were observed in the PDT and SRP protocols at 3 months when compared with the PS protocol (P <0.05). An inferior frequency detection of Porphyromonas gingivalis was observed in the PDT protocol at 3 and 6 months and in the SRP protocol at 6 months from baseline (P <0.05). In addition, PDT protocol presented inferior frequency of P. gingivalis at 3 months when compared with the other therapies (P <0.05). Only patients in the PDT protocol exhibited augmented levels of anti-inflammatory interleukin (IL)-4 and reduced proinflammatory IL-1β and IL-6 throughout the study (P <0.05). Intergroup analyses showed reduced IL-10 and increased interferon-γ and IL-1β levels in the PS protocol when compared with the other therapies during follow-ups (P <0.05). No differences in morbidity were observed between the therapies (P >0.05), although the need for anesthesia was higher in SRP-treated sites (P <0.05).
  
  
  CONCLUSIONS
  PDT as an exclusive therapy may be considered a non-invasive alternative for treating residual pockets, offering advantages in the modulation of cytokines.
authors.affiliation: Dental Research Division, School of Dentistry, Paulista University, São Paulo, São Paulo, Brazil.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Kolbe
authors.forename: Fernanda V
authors.initials: FV
authors.lastname: Ribeiro
authors.forename: Vanessa H
authors.initials: VH
authors.lastname: Luchesi
authors.forename: Renato C
authors.initials: RC
authors.lastname: Casarin
authors.forename: Enilson A
authors.initials: EA
authors.lastname: Sallum
authors.forename: Francisco H
authors.initials: FH
authors.lastname: Nociti
authors.forename: Gláucia M B
authors.initials: GM
authors.lastname: Ambrosano
authors.forename: Fabiano R
authors.initials: FR
authors.lastname: Cirano
authors.forename: Suzana P
authors.initials: SP
authors.lastname: Pimentel
authors.forename: Marcio Z
authors.initials: MZ
authors.lastname: Casati
mesh_terms: D000328:Adult; D000368:Aged; D016976:Aggregatibacter actinomycetemcomitans / Q000187:drug effects / Q000302:isolation & purification; D058491:Bacterial Load / Q000187:drug effects; D055113:Chronic Periodontitis / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D016207:Cytokines / Q000032:analysis; D012534:Dental Scaling / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007371:Interferon-gamma / Q000032:analysis; D053583:Interleukin-1beta / Q000032:analysis; D015847:Interleukin-4 / Q000032:analysis; D015850:Interleukin-6 / Q000032:analysis; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D016966:Porphyromonas gingivalis / Q000187:drug effects / Q000302:isolation & purification; D011446:Prospective Studies; D016745:Root Planing / Q000379:methods; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D016207:Cytokines; C508598:IL4 protein, human; C508600:IL6 protein, human; D053583:Interleukin-1beta; D015850:Interleukin-6; D017319:Photosensitizing Agents; D015847:Interleukin-4; D007371:Interferon-gamma
keywords: Chronic periodontitis; cytokines; microbiology; pain; periodontal pocket; photochemotherapy