Efeito da terapia fotodinâmica como adjuvante ao tratamento periodontal não-cirúrgico e na terapia periodontal de suporte em diabéticos tipo 2: estudo clínico e laboratorial em humanos / Photodynamic therapy as an adjunct to non-surgical periodontal treatment and periodontal maintenance in diabeticss type II. A randomized, controlled clinical and laboratory trial

Guilherme de Oliveira Macedo

The aim of this study was to evaluate the effectiveness of photodynamic therapy (PDT) as an adjunctive treatment to non-surgical periodontal therapy (PT) and periodontal supportive therapy (PST) in chronic periodontitis patients with type 2 diabetics. The study was conducted into two phases. Phase 1: Forty-five diabetics type 2 patients were selected and randomly treated with scaling and root planing (SRP) followed by a single episode of PDT (G1 group/n=30) or SRP alone (G2 group/n=15). Plaque Score (PS), Probing Depth (PD), Clinical Attachment Level (CAL), Bleeding Score (BS), Suppuration (S), Glycated Hemoglobin (HbA1c), and Fasting Glucose (FG) levels were measured at baseline and 3 months after therapy. Samples of subgingival biofilm and crevicular fluid were collected for microbiological and IL1-β analysis respectively. Phase 2: Group G1 was subdivided in two subgroups: G1-R treated with SRP alone (n=15), and G1-F treated with PDT alone (n=15). G2 group was treated with SRP alone (n=15). The results of phase 1 were based on baseline to phase 2 analysis. The same parameters of phase 1 were measured at 3, 6, 9, and 12 months. Mann-Whitney test was applied to assess the differences between groups and Wilcoxon signed rank test for intra-groups differences. Friedman test was applied to assess the differences among 3, 6, 9, and 12 months. A significance level of 5% was established. In phase 1, no significant statistical differences were observed to any parameter evaluated between groups (P<0.05). Intra-groups analysis showed a significant reduction of HbA1C (8.5 ± 0.9 / 7.5 ± 0.1) (P<0.01), and FG (163.53 ± 68.04 / 154 ± 62.45) (P<0.01) for G1 group. There was also a significant reduction of bacterial red complex (P. gingivalis, T. forsythia and T. denticola) (P<0,05). In phase 2, there were no differences between groups for the parameters assessed. There was a significant reduction in the number of sites of 4 and 5 mm and ≥ 6 mm and increase of the number of sites with ≤ 3 mm between 3 months and other times of revaluations (P<0,05). There was a reduction of IL1-β between 3 and 6 months for the G1-R group (P<0,05). It can be concluded that the adjunctive application of a single episode of PDT to scaling and root planing did not show additional improvement in non-surgical periodontal therapy. The PDT in periodontal maintenance showed similar results in relation to the groups G1 and G2- R for all parameters assessed. Therefore, PDT can be used as a substitute of SRP during PST when mechanical instrumentation for plaque and calculus removal is not mandatory.

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