Effects of root debridement and adjunctive photodynamic therapy in residual pockets of patients on supportive periodontal therapy: A randomized split-mouth trial

Background: The study aims to compare the effects of adjunctive photodynamic therapy (PDT) with scaling and root debridement alone on periodontal parameters and inflammatory cytokines in residual pockets of patients undergoing maintenance therapy. Methods: 27 subjects, each with at least 2 residual pockets >= 5 mm, were recruited for this randomized, split-mouth controlled trial, providing total of 72 sites. Probing pocket depth (PPD), recession, clinical attachment loss (CAL), plaque and bleeding on probing of all sites were examined at baseline, 3 and 6 months. Gingival crevicular fluids (GCFs) were collected to determine levels of IL-1 beta, IL-6, IL-8, TNF-alpha. and MMP-8 via enzyme-linked immunosorbent assay. At baseline, all sites received subgingival instrumentation and polishing. In addition, test sites received a single application of PDT using Fotosan (R) with toluidine blue 0 solution photosensitizer. At 3 and 6 months, site level analysis was performed for changes in clinical parameters and cytokine level. Results: Based on mixed model analysis, at 3 months, test sites showed significant reduction in CAL (p = 0.016) and PPD (p = 0.027) (from 6.14 +/- 0.28 mm to 5.49 +/- 0.20 mm and 5.42 +/- 0.16 mm to 4.65 +/- 0.18 mm respectively) compared to control sites (from 6.32 +/- 0.24 mm to 6.08 +/- 0.17 mm and 5.32 +/- 0.13 mm to 5.15 +/- 0.15 mm respectively). At 6 months, these differences were no longer significant (p = 0.510). Adjunctive PDT did not offer additional reduction in levels of GCF cytokines. Conclusions: A single application of PDT to residual pockets provided a modest improvement of CAL and PPD over 3 months. Application of adjunctive PDT may lead to faster resolution of residual pockets and may be recommended for periodontal patients with slower healing capacity. (C) 2017 Elsevier B.V. All rights reserved.