http://bibliotecatede.uninove.br/handle/tede/34 2026-09-20T11:08:42Z http://bibliotecatede.uninove.br/handle/tede/4025 Título: O uso da fotobiomodulação e terapia fotodinâmica antimicrobiana no tratamento de úlceras do pé relacionadas ao diabetes: overview de revisões sistemáticas e consenso pelo método Delphi modificado Autor: Santos, Thaís Barbosa dos Primeiro orientador: Cecatto, Rebeca Boltes Abstract: Diabetes-related foot ulcers constitute one of the most serious and disabling chronic complications of diabetes mellitus, being associated with reduced quality of life, increased risk of amputations, and high morbidity and mortality rates. The healing process of these lesions is often compromised by metabolic and pathophysiological alterations resulting from chronic hyperglycaemia, including persistent inflammation, oxidative stress, microvascular dysfunction, peripheral neuropathy, and increased susceptibility to infections—factors that impair tissue repair and limit the response to conventional treatments. In this context, light-based therapies, such as photobiomodulation (PBM) and antimicrobial photodynamic therapy (aPDT), have been investigated as promising adjunctive therapeutic strategies in the management of these lesions. Scientific evidence suggests that these approaches may favour the wound healing process by modulating the inflammatory response, stimulating angiogenesis, cell proliferation, and collagen synthesis, in addition to contributing to local infection control, reducing the microbial load and biofilm, thereby enhancing tissue repair and clinical recovery of the lesions. This study aimed to develop an expert consensus, based on the best available evidence, regarding the use of PBM and aPDT in the treatment of diabetes-related foot ulcers. This is a methodological study conducted in two complementary stages. Initially, an umbrella review of systematic reviews and meta-analyses was conducted, following PRISMA recommendations and prospectively registered on the PROSPERO platform under number CRD42024589660. Searches were performed in the MEDLINE/PubMed, EMBASE, and LILACS databases, including systematic reviews, meta-analyses, guidelines, and consensus statements that evaluated the effects of PBM and aPDT on diabetes-related foot ulcers. Outcomes related to tissue repair, dosimetric parameters, safety, and adverse events were analysed. In the second stage, the review findings were submitted to an interdisciplinary panel of 20 national and international experts, selected for their expertise in the fields of biophotonics, diabetes, stoma therapy, and podiatry. The consensus was conducted using a modified Delphi technique, over two anonymous rounds administered via an electronic form, employing a Likert scale structured into four response categories. A minimum agreement level of 75% was pre-established to define consensus. Data analysis was performed descriptively and qualitatively through a narrative synthesis of the findings. The methodological quality of the included studies was assessed using the AMSTAR 2 and AGREE II instruments, while the certainty of the evidence and the strength of the available evidence were classified based on the GRADE system. The results of all selected reviews and meta-analyses demonstrated that PBM had positive effects on tissue repair, including accelerated healing and a higher probability of complete closure. aPDT demonstrated relevant potential in reducing the microbial load and consequently improving local tissue repair. Regarding safety, no serious short-term adverse events were identified for either therapy, although mild adverse events were described for aPDT, and studies lacked medium- and long-term assessments. Despite favourable findings, significant methodological heterogeneity was observed among primary studies, particularly concerning dosimetric parameters, biases, small sample sizes, subjective analyses, and the therapeutic protocols employed, which impacted the GRADE analysis. The expert consensus reinforced that both therapies should be used exclusively as adjunctive approaches to standard care. Although definitive consensus on the ideal therapeutic parameters was not established, recommendations regarding indications, monitoring parameters, and dosimetric ranges potentially favourable to tissue repair and clinical lesion management were suggested. Although the available results demonstrate relevant clinical benefits, more robust clinical trials with larger sample sizes, multicentre designs, standardised protocols, and methodological consistency are still needed to strengthen the quality of the evidence and consolidate reproducible therapeutic protocols for the use of PBM and aPDT in the treatment of diabetes-related foot ulcers. The development of comparative studies on dosimetry and parameters is also urgently needed. Instituição: Universidade Nove de Julho Tipo do documento: Dissertação 2026-06-26T00:00:00Z http://bibliotecatede.uninove.br/handle/tede/4024 Título: Efeitos da fotobiomodulação sobre o estresse oxidativo, viabilidade celular e marcadores inflamatórios em macrófagos j774 expostos ao peróxido de hidrogênio Autor: Shaker, MohammadHossein Primeiro orientador: Duran, Cinthya Cosme Gutierrez Abstract: Inflammation and oxidative stress are involved in cellular dysfunction, tissue damage, and the persistence of inflammatory responses. Macrophages participate in innate immunity and modulate cytokine production associated with inflammation and redox balance. Hydrogen peroxide (H₂O₂) is widely used in in vitro models to induce controlled oxidative stress, whereas photobiomodulation (PBM) has been investigated for its effects on mitochondrial activity, cell viability, and inflammatory mediators. This study evaluated the effects of 780-nm PBM on metabolic viability, cell morphology, and TNF-α and IL-6 production in J774A.1 macrophages subjected to H₂O₂-induced oxidative stress. Cells were allocated into seven groups: control, H₂O₂ 50 µM, H₂O₂ 100 µM, H₂O₂ 200 µM, H₂O₂ 50 µM + PBM, H₂O₂ 100 µM + PBM, and H₂O₂ 200 µM + PBM. Oxidative stress was induced by exposure to H₂O₂ for 1 hour. Cells were then washed, centrifuged to obtain a cell pellet, and, in the designated groups, irradiated with a 780-nm infrared laser, 70 mW output power, 1.05 J total energy, 26.25 J/cm² radiant exposure, continuous mode, 15 seconds, one irradiation point, and a single session. Non-irradiated groups underwent the same manipulation with the device turned off. After irradiation or sham manipulation, cells were resuspended in fresh culture medium and incubated for 24 or 48 hours. Cell viability was assessed by MTT assay, morphology by light microscopy, total protein by NanoDrop spectrophotometry, and TNF-α and IL-6 levels by ELISA, with cytokine concentrations normalized to total protein in the supernatant. Data were analyzed using one-way ANOVA followed by Tukey’s post hoc test, with p<0.05 considered significant. H₂O₂ reduced metabolic viability and induced progressive morphological alterations, especially at higher concentrations. At 24 hours, PBM significantly increased viability in the 50 µM + PBM and 200 µM + PBM groups compared with their respective non-irradiated groups; at 48 hours, no significant differences were observed between H₂O₂ and H₂O₂ + PBM groups. Total protein did not differ among groups. H₂O₂ increased TNF-α levels, whereas PBM significantly reduced this cytokine compared with the respective non-irradiated groups. For IL-6, no differences were observed at 24 hours; at 48 hours, the H₂O₂ 100 µM and 200 µM groups showed reduced levels compared with the control group, whereas PBM-treated groups maintained higher IL-6 levels than their respective non-irradiated groups. In conclusion, PBM with a 780-nm laser modulated the response of J774A.1 macrophages subjected to H₂O₂-induced oxidative stress, with better qualitative preservation of cell morphology, increased metabolic viability under specific conditions, reduced TNF-α levels, and maintenance of IL-6 levels in selected groups after 48 hours. Instituição: Universidade Nove de Julho Tipo do documento: Dissertação 2026-06-29T00:00:00Z http://bibliotecatede.uninove.br/handle/tede/4023 Título: Efeito da fotobiomodulação preventiva no edema periorbitário no pós-operatório de rinoplastia: estudo piloto Autor: Azevedo, Milene Alves Primeiro orientador: Duran, Cinthya Cosme Gutierrez Abstract: Periorbital edema is a common manifestation following rhinoplasty and may negatively affect early recovery, patient comfort, and aesthetic perception. This pilot study evaluated the preventive effect of photobiomodulation therapy (PBMT) on postoperative periorbital edema following rhinoplasty. Participants were enrolled in a randomized, double-blind, controlled clinical trial and allocated to either a PBMT group or a sham group. The intervention consisted of a single session performed one hour before surgery using a cluster containing three red laser emitters (660 nm) and three infrared laser emitters (808 nm), applied to three points of the nasal region during the immediate preoperative period. The irradiation parameters were: wavelengths of 660 and 808 nm, output power of 150 mW per emitter, energy of 12 J per emitter, irradiation time of 80 seconds per point, radiant exposure of 108 J/cm² per emitter, total treated area of 21 cm², and total energy of 216 J(applied to 3 points, with two emitters — one red and one infrared — per point). Irradiation was delivered by direct contact to the nasal dorsum and the right and left frontal processes of the maxilla. The sham group underwent the same procedure without therapeutic light emission. The primary outcome was periorbital edema on the third postoperative day, assessed using the categorical clinical scale adapted from Hoffmann et al. (1991). Secondary outcomes included periorbital edema on the seventh postoperative day, ecchymosis, pain, medication consumption, and functional and aesthetic outcomes assessed using the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS). Statistical analyses included comparisons between groups and time points, effect size calculations, and repeated-measures analysis using the Aligned Rank Transform Analysis of Variance (ART ANOVA).The PBMT group presented significantly lower periorbital edema on the third postoperative day compared with the sham group, with significant effects of group, time, and group × time interaction. On the seventh postoperative day, edema remained numerically lower in the PBMT group, although the between-group difference was not statistically significant, and lower medication consumption was observed in the PBMT group compared with the sham group. Trends toward reduced ecchymosis and pain were also observed in the PBMT group at some time points; however, these differences did not reach statistical significance.The findings of this pilot study demonstrate that preventive photobiomodulation reduced periorbital edema on the third postoperative day and decreased medication consumption on the seventh postoperative day, suggesting that PBMT may be a promising strategy for optimizing postoperative recovery following rhinoplasty. Instituição: Universidade Nove de Julho Tipo do documento: Dissertação 2026-06-26T00:00:00Z http://bibliotecatede.uninove.br/handle/tede/4022 Título: Avaliação da terapia fotodinâmica antimicrobiana no tratamento endodôntico de dentes decíduos anteriores com necrose pulpar: ensaio clínico randomizado e controlado com análise microbiológica e a avaliação cega dos desfechos clínicos e radiográficos Autor: Romano, Iara Maria Freitas Primeiro orientador: Bussadori, Sandra Kalil Abstract: Disinfection of the root canal system remains one of the main challenges in the endodontic treatment of primary teeth with pulp necrosis, and antimicrobial photodynamic therapy (aPDT) has been proposed as an adjunctive strategy for intracanal infection control. This study evaluated the efficacy of aPDT in reducing intracanal microbial load and in the clinical and radiographic progression of anterior primary teeth with pulp necrosis. This randomized controlled clinical trial included 20 anterior primary teeth from seven children aged 2 to 5 years, allocated to two groups: conventional endodontic treatment (G1; n = 10) and antimicrobial photodynamic therapy (G2; n = 10). The experimental unit was the tooth. The initial microbiological sample (S1) was collected after coronal access and before the intervention, whereas the final sample (S2) was obtained after chemomechanical preparation in G1 and after aPDT application in G2, without prior chemomechanical preparation or sodium hypochlorite irrigation. The photodynamic protocol employed 0.005% methylene blue (Chimiolux®), with a pre-irradiation time of 3 minutes, followed by one intracanal application per tooth using a red Therapy XT laser (DMC, São Carlos, SP, Brazil), operating in continuous-wave mode at a wavelength of 660 nm, with a mean radiant power of 100 mW, an irradiation time of 90 seconds, and a radiant energy of 9 J, delivered through an intracanal optical fiber. After the interventions and S2 collection, the root canals were filled with UltraCal® XS calcium hydroxide paste (Ultradent, Indaiatuba, SP, Brazil), a thin gutta-percha base was placed, and the teeth were provisionally sealed with Riva® glass ionomer cement (SDI, Bayswater, Victoria, Australia). After seven days, the teeth were reopened for removal of the intracanal medication, followed by irrigation with 1% sodium hypochlorite solution (Milton solution) and definitive root canal filling with Guedes-Pinto iodoform paste. Restorative treatment was performed in a subsequent session. Microbial load was expressed as log₁₀ CFU/mL and analyzed using a linear mixed-effects model, whereas radiographic outcomes were assessed using Generalized Estimating Equations, with a significance level of 5%. A significant group-by-time interaction was observed (p = 0.008). No difference was found between the groups at the pre-intervention time point (p = 0.634); however, after the intervention, the aPDT group showed a lower intracanal microbial load than the conventional treatment group (p = 0.017), with a greater magnitude of microbial reduction (Δ = −0.716 log₁₀ CFU/mL; p < 0.001) compared with the conventional treatment group (Δ = −0.340 log₁₀ CFU/mL; p = 0.001). Clinical and radiographic outcomes showed favorable progression during follow-up, with no statistically significant differences between the groups regarding the presence of periapical lesions. It was concluded that antimicrobial photodynamic therapy promoted a greater immediate reduction in intracanal microbial load, supporting its potential as an adjunctive strategy for intracanal infection control in anterior primary teeth with pulp necrosis. Instituição: Universidade Nove de Julho Tipo do documento: Dissertação 2026-06-22T00:00:00Z