Eficácia da terapia fotodinâmica antimicrobiana e da raspagem em áreas de crescimento gengival predispostas pelo aparelho ortodôntico fixo em adolescentes: estudo clínico controlado randomizado duplo-cego boca dividida

Abstract

It is known that the presence of orthodontic brackets predisposes to the accumulation of biofilm, and the presence of gingival growth associated with orthodontic treatment in adolescents is frequent. The objective of this study was to evaluate the effectiveness of antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling in clinical and inflammatory parameters in adolescents with gingival growth using fixed appliances since the photosensitizer and light are capable of reaching areas of difficult access. In this randomized, controlled, double-blind, split-mouth clinical trial, 20 participants were included who had their mouths divided into: Control Side (n=20) – Scaling + aPDT placebo and Experimental Side (n=20) - Scaling + aPDT. Scaling was performed with the aid of an ultrasonic scaler and aPDT with methylene blue photosensitizer 0.005%, and laser at λ=660nm and 9J of energy per site. Clinical parameters were analyzed: plaque index (PI), gingival index (GI), probing depth (PCS), and clinical attachment level (NCI). Crevicular fluid was collected from 8 sites for analysis of the IL-1β, IL-6, TNF-α, and IL-10 cytokines, using the ELISA method. Analyzes were performed at baseline (T0) and 30 days after treatment (T1). Participants received oral hygiene guidance at T1. The Kolmogorov-Smirnov test assessed the normality of quantitative variables, which were presented as median and interquartile range and compared with the Wilcoxon test. There was an improvement in the control and experimental groups in the clinical variables within 30 days, GA (p<0.001 and p=0.001), PCS (p=0.001 and p=0.001), and IP (p=0.001 and p=0.002), with no difference between the groups. The IL-6 cytokine was reduced in the control and experimental group (p=0.011 and p=0.003), TNF-α decreased values in the experimental group in 30 days (p=0.001), with a tendency to decrease in the experimental group when compared to the control (p=0.087). Final considerations: adjuvant aPDT to scraping and scraping alone showed similar efficacy in clinical and inflammatory outcomes in the treatment of gingival growth in adolescents using orthodontic appliances.