Efeito da terapia fotodinâmica antimicrobiana como adjuvante no tratamento não cirúrgico da periodontite estádio III ou IV grau C

Abstract

Stage III – IV grade C periodontitis in young patients has a more destructive character of periodontal support tissues and has impact on loss of teeth, masticatory function and worse response to treatment. The Antimicrobial Photodynamic Therapy (PDT) has become as a promising alternative, adjuvant to Non-Surgical Periodontal Therapy (NSPT) of this disease. OBJECTIVE: To evaluate the effect of adjunctive PDT on the non-surgical treatment of stage III – IV, grade C Periodontitis, through the analysis of periodontal clinical parameters (Visible Plaque Index (VPI), Gingival Bleeding Index (GBI), Bleeding on Probing (BP), Pocket Probing Depth (PPD), Gingival Recession (GR), Clinical Attachment Level (CAL) and Tooth Mobility (Mob)) as well as to assess their impact on quality of life (QoL) of the patients through Oral health-related quality of life (OHRQoL) questionnaire. METHODOLOGY: Twenty-one subjects particpated in this controlled randomized, double-blind trial, in a split-mouth design divided into quadrants. All the patients were treated with oral hygiene guidance, scaling and root planing through Full Mouth Disinfection (FMD) and systemic anbiotics. The four quadrants were randomly assigned to the following treatment groups: group (FMD + AB), group 2 (FMD + AB + PDT in a single session), group 3 (FMD + AB + PDT in four sessions), and group 4 (FMD + AB + laser therapy with infrared light in four sessions). Assessments were made at baseline and an average of 6 months after treatment. RESULTS: There was an improvement in clinical parameters with significant reduction of PPD, CAL and BoP for all therapies as well as Mob for FMD + AB, FMD + AB + PDT in a sihgle session and FMD + AB + PDT in 4 sessions groups, however there was a significantly greater reduction in CIN in the FMD + AB + PDT group 4 sessions (ΔAverage = 3.04 mm) in relation to the FMD + AB group (ΔAverage = 2.18 mm), that is, with a difference of 0.86 mm. Stratification of the baseline pockets in PPD = 5mm and PPD ≥ 6mm showed that, for PPD ≥ 6mm, FMD + PDT in 4 sessions had a greater reduction of PPD (p = 0.005) and CAL (p = 0.001) in relation to FMD group). Regarding QoL analysis, there was a significant increase in the OHRQoL (p = 0.001) and in the physical (p < 0,001), social (p = 0.027) and psychological (p = 0.005) domains after treatment. CONCLUSION: FMD therapy associated with systemic antibiotic therapy, with or without addition of PDT, showed significant improvement of the clinical periodontal parameters and, in deeper pockets, PDT in 4 sessions showed better results. Furthermore, stage III - IV grade C Periodontitis reflected negatively on the QoL perception, however, NSPT had a positive impact on it.