Avaliação da eficácia da terapia fotodinâmica antimicrobiana no tratamento de peri-implantite ensaio clínico controlado e randomizado

Abstract

The elimination of pathogenic microorganisms from the peri-implant system is one of the success factors in the treatment of peri-implantitis (IP). We conducted a randomized, controlled clinical trial to evaluate the efficacy of papaya gel-mediated antimicrobial photodynamic therapy (PDT) mediated by PapaMblue® (Papaya gel with methylene blue) in the treatment of PI. We selected 20 implants with a PI bag ≥ 5 mm deep, randomly divided into two groups: group I received conventional treatment (scraping, peri-implant calculus removal and curettage of peri-implant pouch); group II received conventional treatment and PDT with FS. Both groups initially received oral hygiene guidance and conventional treatment. In group I, only pre-irradiation of 30s was performed for activation of FS with laser (Therapy EC, DMC, São Carlos, Brazil), wavelength λ = 660 nm and power of 100 mW for 1 minute in the peri-implant pockets. In group II, in addition to this pre-irradiation, PDT was done with FS. In this group we applied the laser for 2 minutes at each site (buccal, lingual, mesio lingual, distal lingual, mesio buccal and distal buccal), equivalent to 30 J/cm2 radiant exposure and power density I = 250 mW/cm2. Microbial samples were collected from both groups before and immediately after treatments and grown in anaerobiosis. The colony forming units were counted and the means were compared by the Shapiro-Wilk normality test and statistically significant for the bacterial reduction. After 30 days of collection, measurements of clinical insertion, bleeding and clinical depth of probing (PCS) were performed, using a significant Mann-Whitney test (p<0.001). The data showed that the PapaMblue® associated PDT decreased the concentration of bacteria in the PI. The control group showed no significant difference in the amount of bacteria after treatment. We conclude that the treatment of peri-implantite with PDT and PapaMblue® presented a significant difference for the reduction of bacteria quantity and decrease of PCS inside the peri-implant pocket.