Photodiagnosis and Photodynamic Therapy

Clinical and microbiological effects of multiple applications of antibacterial photodynamic therapy in periodontal maintenance patients. A randomized controlled clinical study Publication date: September 2019 Source: Photodiagnosis and Photodynamic Therapy, Volume 27 Author(s): K. Grzech-Leśniak, B. Gaspirc, A. Sculean Abstract Background At present, very limited data are available on the clinical and microbiological outcomes obtained following repeated application of aPDT following one single mechanical debridement. Objective To evaluate clinically and microbiologically the outcomes following one single session of subgingival mechanical debridement (scaling and root planing; e.g. SRP) followed by 1x immediate application of aPDT and 2 x subsequent use of aPDT without SRP. Materials and methods Forty patients diagnosed with generalized chronic periodontitis that were enrolled in periodontal maintenance (supportive periodontal therapy) program, were randomly assigned to one of the two treatments: 1. SRP by means of ultrasonic and hand instruments followed by one single session of SRP followed by 1x immediate application of aPDT and 2 x subsequent applications of aPDT without SRP (test) or 2. SRP alone (control). The following clinical parameters were recorded at baseline, at 3 and 6 months: Full-Mouth Plaque Scores (FMPS), Full-Mouth Bleeding Scores (BOP), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL) and Gingival Recession (RC). Additionally, microbiological samples were evaluated at baseline and six months after treatment. The primary outcome variable was BOP. Results Both treatments improved statistically significantly (p < 0.05) the FMPS, PPD and CAL values, while no statistically significant changes occurred in terms of RC. In the test group, BOP decreased statistically significantly (p < 0.05) after 3 and 6 months, while in the control group the respective values decreased statistically significantly only at 3 months. Both treatments reduced statistically significantly the total bacteria counts (TBC) after 6 months (p < 0.05). At 6 months, the use of SRP and aPDT resulted in a statistically significant decrease in the number of all tested bacteria except A. actinomycetemcomitans while the use of SRP alone resulted only in a statistically significant decrease in the numbers of P. gingivalis, T. denticola and T. forsythia. Conclusions In periodontal patients enrolled in a maintenance program one single session of SRP followed by 3x application of aPDT, enhanced the clinical and microbiological outcomes compared to SRP alone.

ALA-PDT combined with holmium laser therapy of postoperative recurrent extramammary Paget's disease Publication date: September 2019 Source: Photodiagnosis and Photodynamic Therapy, Volume 27 Author(s): Chunxiao Li, Lehang Guo, Peiru Wang, Lei Shi, Xiaofei Sun, Chan Hu, Guolong Zhang, Linglin Zhang, Yunfeng Zhang, Xiuli Wang Abstract Extramammary Paget's disease (EMPD) is a rare intraepithelial neoplasm arising in apocrine rich area of the skin. Surgery is the standard treatment but relapse is common. The postoperative skin defects, penile reconstruction, functional effects and old age are also challenges for curing disease. Herein, a case of postoperative recurrent EMPD, which was treated by combination therapy of non-invasive repeatable ALA-PDT and deep penetrated holmium laser is reported. Ultrasonography monitor of lesions showed light vascularity and the formerly hypoechoic lesion disappeared after treatment.

Impact of tooth-related factors on photodynamic therapy effectiveness during active periodontal therapy: A 6-months split-mouth randomized clinical trial Publication date: September 2019 Source: Photodiagnosis and Photodynamic Therapy, Volume 27 Author(s): Laetitia Harmouche, Aymeric Courval, Anne Mathieu, Catherine Petit, Olivier Huck, Francois Severac, Jean-Luc Davideau Abstract Background The persistence of periodontal pockets > 5 mm after periodontal treatments increases the risk of periodontitis recurrence and the need of periodontal surgery. This study evaluated the impact of tooth-related factors on the effectiveness of adjunctive photodynamic treatment (PDT) in the reduction of pockets > 5 mm during active periodontal treatment. Methods Thirty-six patients suffering from severe chronic periodontitis were evaluated in a 6-months split-mouth randomized clinical trial. Each quadrant was assigned to test (scaling and root planing (SRP) + PDT) or control (SRP alone) group. PDT was conducted using the toluidine blue O and a light-emitting diode (LED) with a red spectrum. PDT applications were performed immediately after SRP, 7 days later and at 3 months. Plaque index (PI), bleeding on probing (BOP), periodontal pocket depth (PPD), and clinical attachment level (CAL) were recorded at baseline, 3 and 6 months. Results Multilevel analysis showed a significant reduction of pockets > 5 mm in test group in comparison with control group at 3 (OR = 0.69) and 6 months (OR = 0.77). This effect was mainly observed at 6 months in initially deep sites (PPD > 6 mm) with BOP (OR = 0.57). At sites exhibiting PI > 1 no PDT effect was observed. A more moderate PDT effect was observed on mean PPD and BOP reductions at 3 months only. Conclusions Repeated applications of PDT significantly improved SRP outcomes, reducing by more than 40% residual pockets > 5 mm in initially deep and bleeding on probing periodontal sites. PDT effect was negatively influenced by dental plaque accumulation.

Optical coherence tomography angiography to assess vascular remodeling of the choriocapillaris after low-fluence photodynamic therapy for chronic central serous chorioretinopathy Publication date: September 2019 Source: Photodiagnosis and Photodynamic Therapy, Volume 27 Author(s): Gilda Cennamo, Michela Cennamo, Giuseppe Caputo, Federica Mirra, Pia Clara Pafundi, Giuseppe de Crecchio, Giovanni Cennamo Abstract Background To evaluate the efficacy of optical coherence tomography angiography (OCTA) in identifying changes in the choriocapillaris layer after low-fluence verteporfin photodynamic therapy (vPDT) in patients affected by chronic central serous chorioretinopathy (CSCR). Methods Low-fluence vPDT was performed on 28 eyes of 27 patients with CSCR. All patients underwent the following tests at baseline and 6 months after treatment: best corrected visual acuity (BCVA), fluorescein angiography, indocyanine green angiography, enhanced depth imaging OCT and OCTA. Results Subretinal fluid was completely absorbed in 18 of the 28 affected eyes (64.3%) after low-fluence vPDT ("responders"), and incompletely absorbed in 10 eyes (35.7%) ("non responders"). BCVA was significantly improved (p = 0.006) whereas central foveal thickness and choroidal foveal thickness were significantly decreased (p = 0.001 and p = 0.00 respectively) 6 months after treatment in responders. Conclusions OCTA revealed a different pattern of vascular remodeling of the choriocapillaris between CSC patients who responded and those who did not respond to low-fluence vPDT.

Diagnosis of cervical squamous cell carcinoma and cervical adenocarcinoma based on Raman spectroscopy and support vector machine Publication date: September 2019 Source: Photodiagnosis and Photodynamic Therapy, Volume 27 Author(s): Chengxia Zheng, Song Qing, Jing Wang, Guodong Lü, Hongyi Li, Xiaoyi Lü, Cailing Ma, Jun Tang, Xiaxia Yue Abstract In this report, we collected the Raman spectrum of cervical adenocarcinoma and cervical squamous cell carcinoma tissues by a micro-Raman spectroscopy system. We analysed, compared and summarized the characteristics and differences of the normalized mean Raman spectra of the two tissues and pointed out the major differences in the biochemical composition between the two tissues. The PCA-SVM model that was used to distinguish the two types of cervical cancer tissues was established. The accuracy of the model in differentiating cervical adenocarcinoma from cervical squamous cell carcinoma was 93.125%. The results of this study indicate that Raman spectroscopy of cervical adenocarcinoma and cervical squamous cell carcinoma tissue in combination with SVM (support vector analysis) and PCA (principal component analysis) can be useful for the classification of cervical adenocarcinoma and cervical squamous cell carcinoma tissues and for the exploration of the differences in biochemical compositions between the two types of cervical tissue. This study lays a foundation to further study Raman spectroscopy as a clinical diagnostic method for cervical cancer.

Facile spectroscopy and atomic force microscopy for the discrimination of α and β thalassemia traits and diseases: A photodiagnosis approach Publication date: September 2019 Source: Photodiagnosis and Photodynamic Therapy, Volume 27 Author(s): Khalid E. AlZahrani, Sandhanasamy Devanesan, Vadivel Masilamani, Fatima Al Qahtani, Mohamad S. AlSalhi, Duran Canatan, Karim Farhat Abstract Thalassemia (Thal) is an inherited blood disorder endemic to the Mediterranean and Middle East (e.g., KSA and UAE). This disease is caused by defects in the synthesis of one or more hemoglobin chains in red blood cells (RBCs). Alpha (α) Thal is caused by a reduced or absent alpha globin segment. Similarly, beta (β) Thal is caused by a defect in the beta globin segment. We divided the diseases into four groups: α Thal trait, α Thal disease, β Thal trait, and β Thal disease. The α or β Thal traits are milder variants of these diseases and do not require treatment; but β Thal disease (and to a lesser extent, α Thal) causes hemolytic anemia, splenomegaly, and bone deformities and requires repeated lifelong blood transfusions. This paper presents results regarding the identification of Thal variants using fluorescence spectroscopy of blood biomolecules and atomic force microscopy analysis of the morphologic features of red blood cells. The combined results provide new insights into the characteristics of these diseases. Furthermore, this study shows why β Thal disease subjects are often transfusion-dependent, and α Thal disease subjects are only occasionally transfusion dependent.

Pulsed xenon ultraviolet and non-thermal atmospheric plasma treatments are effective for the disinfection of air in hospital blood sampling rooms Publication date: September 2019 Source: Photodiagnosis and Photodynamic Therapy, Volume 27 Author(s): Shan-Ni Wang, Jing-Jing Li, Ying-Xin Liu, Zhi Lin, Jiao-Jiao Qiao, Li-Hua Chen, Yu Li, Yong Wu, Mei-Mei Wang, Yun-Bo Liu, Chen Yan, Zhi-Heng Chen, Chang-Qing Gao Abstract Background and objectives Non-thermal atmospheric plasma treatment and pulsed xenon ultraviolet (PX-UV) treatment are widely used in disinfection of hospital environments. However, their effectiveness has not been evaluated against a comparator. The objective of this study is to evaluate their effectiveness in the disinfection of pathogens in the air in hospital blood sampling rooms. Methods Samples were taken from the air before and after disinfection with PX-UV and non-thermal atmospheric plasma. We counted bacterial colonies and identified the types of bacteria. Results Non-thermal plasma treatment significantly reduced bacterial counts in the air, the median reduced from 1 before treatment to zero afterwards (p = 0.03). PX-UV treatment also significantly reduced bacterial counts in the air (p = 0.01), the median reduced from 1.5 before treatment to zero afterwards. Pathogens identified in the current study include nosocomial bacteria, such as Staphylococcus aureus, Staphylococcus epidermidis, and yeast. Conclusion Disinfection of blood sampling sites is essential in a health service department. The efficiency of PX-UV and non-thermal atmospheric plasma treatment are comparable in air disinfection.

Parameters for antimicrobial photodynamic therapy on periodontal pocket—Randomized clinical trial Publication date: September 2019 Source: Photodiagnosis and Photodynamic Therapy, Volume 27 Author(s): Letícia H. Alvarenga, Ana Carolina Gomes, Pamela Carribeiro, Bianca Godoy-Miranda, Giovane Noschese, Martha Simões Ribeiro, Ilka Tiemy Kato, Sandra Kalil Bussadori, Christiane Pavani, Yhago Gazote Eloy Geraldo, Daniela de Fátima Teixeira da Silva, Anna Carolina Ratto Tempestini Horliana, Mark Wainwright, Renato Araujo Prates Abstract Background Antimicrobial photodynamic therapy (aPDT) has been investigated as an adjunctive to periodontal treatment but the dosimetry parameters adopted have discrepancies and represent a challenge to measure efficacy. There is a need to understand the clinical parameters required to obtain antimicrobial effects by using aPDT in periodontal pockets. The aim of this study was to investigate parameters relating to the antimicrobial effects of photodynamic therapy in periodontal pockets. Material and methods This randomized controlled clinical trial included 30 patients with chronic periodontitis. Three incisors from each patient were selected and randomized for the experimental procedures. Microbiological evaluations were performed to quantify microorganisms before and after treatments and spectroscopy was used to identify methylene blue in the pocket. A laser source with emission of radiation at wavelength of ʎ = 660 nm and output radiant power of 100 mW was used for 1, 3 and 5 min. One hundred μM methylene blue was used in aqueous solution and on surfactant vehicle. Results The results demonstrated the absence of any antimicrobial effect with aqueous methylene blue-mediated PDT. On the other hand, methylene blue in the surfactant vehicle produced microbial reduction in the group irradiated for 5 min (p < 0.05). Spectroscopy showed that surfactant vehicle decreased the dimer peak signal at 610 nm. Conclusion Within the parameters used in this study, PDT mediated by methylene blue in a surfactant vehicle reached significant microbial reduction levels with 5 min of irradiation. The clinical use of PDT may be limited by factors that reduce the antimicrobial effect. Forms of irradiation and stability of the photosensitizers play an important role in clinical aPDT.

DNase increases the efficacy of antimicrobial photodynamic therapy on Candida albicans biofilms Publication date: September 2019 Source: Photodiagnosis and Photodynamic Therapy, Volume 27 Author(s): Beatriz H.D. Panariello, Marlise I. Klein, Fernanda Alves, Ana Cláudia Pavarina Abstract Antimicrobial Photodynamic Therapy (aPDT) has been proposed as a means to treat Candida infections. However, microorganisms in biofilms are less susceptible to aPDT than planktonic cultures, possibly because the matrix limits the penetration of the photosensitizer. Therefore, the goals here were: (1) to target biofilm matrix components of a fluconazole-susceptible (S) and a fluconazole-resistant (R) C. albicans (Ca) strains using the hydrolytic enzymes β-glucanase and DNase individually or in combination; (2) to apply the best enzyme protocol in association with aPDT mediated by Photodithazine® (PDZ); (3) to verify under confocal microscope the penetration of PDZ in biofilms pre-treated or not with DNase at different periods of incubation. CaS and CaR 48h-old biofilms were incubated with the hydrolytic enzymes (5 min) and evaluated by cell viability, biomass, and matrix components. DNase showed the best outcomes by significantly reducing extracellular DNA (eDNA) and soluble proteins from the matrix of both strains; and water-soluble polysaccharides from CaR matrix. Subsequently, 48h-old biofilms were incubated with DNase for 5 min, followed by incubation with PDZ for 20 min and exposure to LED light (660 nm, 50 J/cm²). Controls were biofilms treated only with aPDT without DNase, PDZ only, PDZ + DNase, light only, light + DNase, and biofilm without treatment. Pre-treatment with DNase allowed PDZ penetration into deeper biofilm layers, and the aPDT effect was enhanced, showing a significant reduction of the cell viability (p = 0.000) and eDNA amounts (p ≤ 0.047). DNase affected the matrix composition improving the penetration of the photosensitizer, thereby, improving the effectiveness of subsequent aPDT.

Adjunctive application of antimicrobial photodynamic therapy in the prevention of medication-related osteonecrosis of the jaw following dentoalveolar surgery: A case series Publication date: September 2019 Source: Photodiagnosis and Photodynamic Therapy, Volume 27 Author(s): Pier Paolo Poli, Francisley Ávila Souza, Susanna Ferrario, Carlo Maiorana Abstract Background Medication-related osteonecrosis of the jaw (MRONJ) is a debilitating complication strongly associated to antiresorptive agents. The present study aimed to describe the use of antimicrobial photodynamic therapy (aPDT) in the prevention of MRONJ. Methods The sample consisted of 11 non-oncologic osteoporotic subjects in therapy with non-intravenous antiresorptive agents, requiring tooth extractions and/or implant removal. After minimally invasive surgical extractions, each alveolar socket was debrided and bony edges were smoothened. At this point, aPDT was performed using methylene blue-based phenothiazine chloride dye irradiated with a hand-held 100 mW diode laser with a wavelength of 660 ± 10 nm. Flaps were sutured to achieve first intention closure. Soft tissue healing was promoted with weekly applications of low-level laser therapy for 6 weeks. Recall visits were scheduled weekly for the first two months and monthly thereafter up to 6 months. At the 6-month appointment, healing was assessed clinically and radiographically. Results A total of 62 surgical extractions were performed in both jaws, including 51 natural elements and 11 dental implants. No intraoperative complications were observed. Immediate post-operative period was generally uneventful except for mild pain and ecchymosis that occurred rarely and resolved spontaneously. Healing proceeded uneventfully, with no clinical or radiological prodromal manifestations of MRONJ up to the latest follow-up visit. Conclusions aPDT might constitute a promising preventive treatment to reduce the risk of MRONJ in non-oncologic osteoporotic patients treated with non-intravenous antiresorptive agents that underwent dentoalveolar surgery.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
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alsfakia@gmail.com