Eficacia clínica de la terapia fotodinámica por 5-ALA tópico en el manejo onco-preventivo de lesiones de leucoplasia oral. Una revisión sistemática / Clinical efficacy of topical 5-ALA photodynamic therapy in the onco-preventive management of oral leukoplakia lesions. A systematic review

Objetivo: La leucoplasia oral es el desorden maligno de la mucosa bucal más prevalente a nivel global y su manejo clínico sigue siendo un desafío. Se llevó a cabo una revisión sistemática para determinar la eficacia clínica de la terapia fotodinámica mediada por ácido 5-aminolevulínico tópico como una alternativa de quimio-prevención para las diferen- tes formas clínicas de la leucoplasia oral. Materiales y métodos: Empleando términos MeSH, se realizó una búsqueda exhaustiva en diferentes bases digi- tales de ensayos clínicos publicados en inglés en los últimos 30 años acerca del uso de la terapia fotodinámica mediada por ácido 5-aminolevulínico tópico como fotosensibilizador, y radiación láser de baja intensidad o luz LED como posibles fuentes de iluminación. Resultados: La revisión sistematizada que aplicó la guía PRISMA mostró una eficacia del 88,6% para este modo de fototerapia en el manejo de leucoplasias orales, con un 60,7% de respuesta completa y 27,9% de respuesta parcial. Además, el tamaño de efecto fue mayor para las formas clíni- cas homogéneas con cambios displásicos, independientemen- te del tipo de fuente de luz. La ausencia de respuesta fue del 11,4%, pero la evidencia empleada en este análisis fue mo- derada. Conclusión: La terapia fotodinámica mediada por áci- do 5-aminolevulínico tópico parece ser una alternativa útil en el manejo onco-preventivo de lesiones de leucoplasia oral. Sin embargo, es recomendable ejecutar ensayos clínicos controla- dos y aleatorizados con metodologías homogéneas que per- mitan generar un meta-análisis con un alto nivel de evidencia

Aim: Oral leukoplakia is globally the most prevalent ma- lignant disorder of the oral mucosa and its clinical manage- ment remains a challenge. A systematic review was carried out to determine the clinical efficacy of photodynamic therapy mediated by topical 5-aminolevulinic acid as an alternative for chemoprevention in the different clinical forms of oral leu- koplakia. Materials and methods: Using MeSH terms, an ex- haustive search was carried out in different digital databases of clinical trials published in English in the last 30 years on the use of photodynamic therapy mediated by topical 5-ami- nolevulinic acid as a photosensitizer, and low-intensity laser radiation or LED light as possible lighting sources. Results: The systematized review using PRISMA guide- lines showed an efficacy of 88.6% for this mode of photother- apy in the management of oral leukoplakias, based on 60.7% of complete response and 27.9% of partial response. In addi- tion, the effect size was larger in homogeneous clinical forms with dysplastic changes, regardless of the type of light source. There was an 11.4% of absence of response, but the evidence used in this analysis was moderate. Conclusion: Photodynamic therapy mediated by topical 5-aminolevulinic acid seems to be a useful alternative in the onco-preventive management of oral leukoplakia lesions. However, it is recommendable to perform controlled and ran- domized clinical trials with homogeneous methodologies that allow the generation of a meta-analysis with a high level of evidence (AU)

Terapia fotodinâmica com verteporfina associada à injeção intravítrea de antifator de crescimento endotelial vascular para tratamento de hemangioma circunscrito de coroide / Photodynamic therapy with verteporfin associated with intravitreal injection of vascular endothelial growth factor for the treatment of circumscribed choroidal hemangioma

RESUMO O hemangioma de coroide é um tumor vascular benigno, de coloração vermelho-alaranjada, bem delimitado, caracterizado por uma placa elevada. É um tumor raro, com prevalência de um caso a cada 40 tumores de coroide. O diagnóstico pode ser feito por meio da clínica associada à avaliação biomicroscópica e a exames complementares para diferenciação de outros tumores. O tratamento pode ser expectante nos casos assintomáticos. Para os casos sintomáticos ou com presença de fluido sub-retiniano, existem diversas terapias. O objetivo deste estudo foi relatar um caso de hemangioma circunscrito de coroide submetido a tratamento combinado de terapia fotodinâmica com verteporfina e injeção intravítrea de antiangiogênico (bevacizumabe). A decisão de tratar um hemangioma de coroide deve ser individualizada com base nos sintomas, na perda visual e em qualquer potencial de sua recuperação. O exame oftalmológico completo é necessário, mesmo em casos assintomáticos, para rastreamento precoce de doenças oculares.

ABSTRACT Choroid hemangioma is a benign, well-delimited orange-red, vascular tumor characterized by an elevated plaque. It is a rare tumor with a prevalence of one case in every 40 choroidal tumors. It can be diagnosed by the clinic associated with biomicroscopic evaluation and complementary tests to differentiate from other tumors. Treatment can be expectant in asymptomatic cases. For symptomatic cases or those with the presence of subretinal fluid, there are several therapies. The objective of this study was to report a case of circumscribed choroidal hemangioma submitted to combined treatment of photodynamic therapy with verteporfin and intravitreal injection of an antiangiogenic agent (bevacizumab). The decision to treat choroidal hemangioma must be individualized based on symptoms, visual loss, and any potential for recovery. A complete eye examination is necessary, even in asymptomatic cases, for early screening for eye diseases.

Efeito in vitro da laserterapia e da terapia fotodinâmica na redução de bactérias presentes em canais radiculares / In vitro effect of lasertherapy and photodynamic therapy in bacterial reduction presents in root canals

Este estudo tem por objetivo verificar in vitro o efeito bactericida da laserterapia e da terapia fotodinâmica com laser de baixa potência (660 nm e 808 nm) em bactérias presentes nos canais radiculares. Métodos: foram preparadas 60 placas de Petri com bactérias: 20 placas com Enterococcus faecalis, 20 placas com Staphylococcus aureus e 20 com Pseudomonas aeruginosa. Aleatoriamente, dividiu-se cada grupo em 10 subgrupos (duas placas cada): três subgrupos tratados com laserterapia 660 nm em doses de 150, 225 e 300J/ cm², três subgrupos tratados com terapia fotodinâmica (azul de metileno 0,2% e laser 660 nm) em doses de 150, 225 e 300J/cm²; um subgrupo tratado com laserterapia 808 nm na dose de 225J/cm², um subgrupo com terapia fotodinâmica e laser 808 nm, em dose 225J/cm²; um subgrupo tratado apenas com fotossensibilizante (FS), e um não tratado (controle). Os tratados com laserterapia e terapia fotodinâmica foram irradiados uma única vez e incubados por 24 horas. Os últimos dois não receberam irradiação. As culturas foram analisadas visualmente para verificação do halo de inibição. Nos grupos submetidos somente à laserterapia, para o grupo FS e para o grupo controle, não foram observados halos de inibição, já onde houve aplicação da TFD, tanto com L1 quanto com L2, observaram-se halos de inibição em todas as espécies bacterianas estudadas. Conclui-se que a laserterapia, não produziu efeitos bactericidas e/ou bacteriostáticos, enquanto a terapia fotodinâmica nos dois comprimentos de onda produziu halos significativos de inibição de crescimento nas três bactérias do estudo.(AU)

This study aims to verify in vitro the bactericidal effect of laser therapy and photodynamic therapy with low power laser (660 nm and 808 nm), in bacteria present in the root canals.Methods: 60 Petri dishes were prepared with bacteria: 20 plates with Enterococcus faecalis, 20 plates with Staphylococcus aureus and 20 with Pseudomonas aeruginosa. At random, each group was divided into 10 subgroups (two plates each): three subgroups treated with 660nm laser therapy at doses of 150, 225 and 300J / cm², three subgroups treated with photodynamic therapy, (0.2% methylene blue and laser 660nm) in doses of 150, 225 and 300J / cm²; a subgroup treated with 808nm laser therapy at a dose of 225J / cm², a subgroup with (photodynamic therapy and 808nm laser) at a dose of 225J / cm²; a subgroup treated only with photosensitizer(FS), and an untreated (control). Those treated with laser therapy and photodynamic therapy were irradiated only once and incubated for 24 hours. The last two received no radiation. The cultures were analyzed visually to check the inhibition zone. In the groups submitted to laser therapy only, for the FS group and for the Control group, no inhibition halos were observed, since PDT was applied, with both L1 and L2, inhibition halos were observed in all studied bacterial species. It was concluded that laser therapy did not produce bactericidal and / or bacteriostatic effects, while photodynamic therapy at both wavelengths produced significant growth inhibition halos in the three studied bacteria.(AU)

Especificidad y Sensibilidad de Sistema ICDAS TM versus Índice COPD en la Detección de Caries / Specificity and Sensitivity of the ICDAS TM System versus the DMFT Index in Caries Detection

RESUMEN: La caries dental no tratada es la enfermedad crónica más frecuente en adultos y la caries no tratada en dientes temporales es la décima enfermedad crónica más frecuente. En Chile los adultos presentan un COPD promedio entre 3,76 - 22,16, pero los estudios no son en población representativa y no existen estudios comparativos entre ceod/ COPD e ICDASTM. A nivel mundial, su prevalencia puede alcanzar el 100 % de la población estudiada. Se buscará evaluar si existen diferencias en la sensibilidad y especificidad en la detección de caries utilizando ICDASTM y ceod/COPD. Se realizó una revisión sistemática cualitativa realizando una búsqueda sobre los índices de caries ceod/COPD y sistema ICDASTM, tanto en Chile como a nivel mundial, en las bases de datos Medline, ClinicalKey y SciELO encontrando 3.581, de ellos, 21 se leyeron por completo y 14 cumplieron nuestros criterios. La sensibilidad y especificidad es mayor con ICDASTM que con el índice ceod/COPD y entrega hasta un 43 % más información al detectar lesiones no cavitadas, pero necesita de mayor tiempo para su realización y más recursos al utilizar luz, aire comprimido y una profilaxis previa al examen. Capacitaciones previas, conocimientos y experiencia en ICDASTM son fundamentales para el mejor resultado, estudios demostraron que mientras mayor experiencia, la sensibilidad y especificidad aumentaba a diferencia del índice ceod/COPD. Se deben realizar más estudios comparativos entre ambos índices e incluir ICDASTM en niños por su capacidad de detectar lesiones no cavitadas las cuales son las más prevalentes en dientes temporales.

ABSTRACT: Untreated dental caries is the most frequent chronic disease in adults and untreated caries in primary teeth is the tenth most frequent chronic disease. In Chile, adults have an average DMFT between 3.76-22.16, but the studies are not in a representative population and there are no comparative studies between dmft/DMFT and ICDASTM. Worldwide, its prevalence can reach 100 % of the population studied. The objective of the study was to evaluate if there are differences in the sensitivity and specificity in the detection of caries using ICDASTM and dmft/DMFT. A qualitative systematic review was done, carrying out a search on the dmft/DMFT index and the ICDASTM system, both in Chile and worldwide, in the Medline, ClinicalKey and SciELO databases, finding 3,581, of which, 21 were read completely and 14 met the inclusion and exclusion criteria. The sensitivity and specificity is greater with ICDASTM than with the dmft/DMFT index and delivers up to 43 % more information when detecting non-cavitated lesions, but it needs more time for its realization and more resources because it needs to use light, compressed air and prophylaxis before the examination. Previous training, knowledge and experience in ICDASTM are fundamental for the best results. Studies showed that the greater the experience, the sensitivity and specificity increased, unlike the dmft/DMFT index. More comparative studies should be conducted between both indexes and include ICDASTM in children for their ability to detect non-cavitated lesions, which are the most prevalent in temporary teeth.

5-Aminolevulinic acid photoactivated over planktonic and biofilm forms of Enterococcus faecalis as a pharmacological therapy alternative

The purpose of the study was to evaluate the antibacterial effect of protoporphyrin IX (PpIX) generated by the exogenous administration of 5-aminolevulinic acid or δ-ALA and activated with an argon laser over a planktonic and biofilm of Enterococcus faecalis (E. faecalis) as a pharmacological therapy alternative. A planktonic strain of E. faecalis was cultured with a solution of ∂-ALA (40 µg/mL)-thioglycolate solution for 13 min, and a biofilm of E. faecalis was cultured in a δ-ALA (80 µg/mL)-thioglycolate solution for 13 min. Then, both were irradiated with an argon laser. Finally, the antibacterial effect was evaluated by counting the CFU in planktonic form, and a LIVE/DEAD viability cell test. The production and accumulation of PpIX from exogenously administered δ-ALA on E. faecalis in planktonic and biofilm forms was confirmed by spectrofluorometry. The irradiation of PpIX with an argon laser produced an antibacterial effect on E. faecalis in planktonic and biofilm form, even without biofilm disruption, at a concentration of 40 µg/mL and 80 µg/mL of δ-ALA, respectively. The exogenous administration of δ-ALA in combination with laser irradiation on planktonic and biofilm forms of E. faecalis produces an effective antibacterial effect as complement or alternative to pharmacological therapies

Eficácia antimicrobiana da terapia fotodinâmica no tratamento da candidíase oral em pessoas vivendo com HIV/Aids / Antimicrobial efficacy of photodynamic therapy on the treatment of oral candidiasis in people living with HIV/Aids / Eficacia antimicrobiana de la terapia fotodinámica en el tratamiento de la candidiasis bucal en personas viviendo con VIH/Sida

Objetivo: avaliar a eficácia antimicrobiana da terapia fotodinâmica no tratamento da candidíase oral em pessoas vivendo com HIV/aids. Método: estudo experimental, qualitativo e descritivo com 18 pessoas vivendo com HIV/aids que manifestavam a candidíase oral, maiores de 18 anos, que estavam em tratamento no Hospital Universitário Gaffrée e Guinle. Este grupo subdividiu-se em um grupo controle, composto por sete pessoas, que recebeu tratamento com a terapia fotodinâmica e antifúngicos, e um grupo experimental, com 11, que recebeu apenas a terapia fotodinâmica. A evolução do tratamento de cada participante foi acompanhada por registros fotográficos em duas consultas, inicial e final. Esta pesquisa foi aprovada pelo Comitê de Ética em Pesquisa do hospital, parecer número 2.431.107. Resultados: a maioria dos participantes apresentou melhora clínica, ainda que discreta, e em apenas um houve piora clínica. Conclusão: a terapia fotodinâmica antimicrobiana pode ser eficaz no tratamento da candidíase oral em pessoas vivendo com HIV/Aids

Objective: evaluate the antimicrobial efficacy of photodynamic therapy in the treatment of oral candidiasis in people living with HIV/ aids. Method: experimental, qualitative and descriptive study with 18 people living with HIV/aids who presented oral candidiasis, over 18 years of age, who were being treated at the Gaffrée and Guinle University Hospital. This group was subdivided into a control group, composed of seven people, who received treatment with photodynamic and antifungal therapy, and an experimental group, with 11, who received only the photodynamic therapy. The evolution of the treatment of each participant was followed by photographic registers in two appointments, initial and final. This research was approved by the Research Ethics Committee from the hospital, dictum number 2.431.107. Results: most of the participants showed clinical improvement, albeit discrete, and in only one there was clinical worsening. Conclusion: antimicrobial photodynamic therapy may be effective in the treatment of oral candidiasis in people living with HIV/Aids

Objetivo: evaluar la eficacia antimicrobiana de la terapia fotodinámica en el tratamiento de la candidiasis bucal en personas que viven con VIH/sida. Método: estudio experimental, cualitativo y descriptivo con 18 personas viviendo con VIH/sida que manifestaban la candidiasis bucal, mayores de 18 años, que estaban en tratamiento en el Hospital Universitario Gaffrée y Guinle. Este grupo se subdividió en grupo control, compuesto por siete personas, que recibió tratamiento con la terapia fotodinámica y antifúngicos, y un grupo experimental, con 11, que recibió sólo la terapia fotodinámica. La evolución del tratamiento de cada participante fue acompañada por registros fotográficos en dos consultas, inicial y final. La investigación fue aprobada por el Comité de Ética en Investigación del lugar, dictamen número 2.431.107. Resultados: la mayoría de los participantes presentó mejoría clínica, aunque discreta, y en apenas uno hubo empeoramiento clínico. Conclusión: la terapia fotodinámica antimicrobiana puede ser eficaz en el tratamiento de la candidiasis bucal en personas que viven con el VIH/Sida

Análise da eficácia do crosslinking transepitelial em pacientes portadores de ceratocone / Analysis of the effectiveness of transepithelial crosslinking in patients with keratoconus

Resumo Objetivo: Avaliar os resultados clínicos do Crosslinking Transepitelial (CXL) analisando sua eficácia em pacientes portadores de ceratocone progressivo. Métodos: Estudo transversal retrospectivo com 49 olhos e 37 pacientes com idades entre 10 e 50 anos, submetidos à técnica de CXL em 2017 no Instituto Panamericano da Visão, em Goiânia, Goiás, Brasil. Foi utilizado o sistema KXL Avedro programado no modo pulsado com intervalo (1/1 segundo), usando 45 mW/cm² com 7,2 J e solução de riboflavina a 0,25% da Avedro com córneas irradiadas por 8 minutos. Foram coletados os dados: sexo, idade, acuidade visual sem correção (AVSC), acuidade visual com correção (AVCC), astigmatismo, paquimetria no ponto mais fino e astigmatismo ceratométrico no pré-operatório e pós-operatório com 1, 6 e 12 meses. Foram utilizados os testes Kolmogorov-Smirnov, Qui-quadrado de Pearson, Friedman, Dunnett à posteriori e a correlação de Spearman. Resultados: Vinte e três pacientes (62,2%) eram do sexo feminino e 14 (37,8%) do sexo masculino. A média de idade foi de 27,89 (±10,89) anos. A AVSC e AVCC melhoraram significativamente no pré-operatório em relação a 1 mês (p=0,01) e (p<0,001), 6 meses (p<0,001 ambas) e 12 meses (p<0.001 ambas). O astigmatismo reduziu significativamente no pré-operatório em relação a 6 meses (p=0,02) e 12 meses (p=0,02). A paquimetria no ponto mais fino manteve-se constante no período (p=0,95). A diferença entre k2 e k1 (astigmatismo ceratométrico) mostrou redução significativa no pré-operatório em relação a 1 mês (p=0,01). Conclusão: A técnica de CXL foi segura e eficaz no tratamento e estagnação da doença em pacientes com ceratocone progressivo.

Abstract Objective: To evaluate the clinical results of Transepithelial Crosslinking (CXL) by analyzing its efficacy in patients with progressive keratoconus. Methods: Retrospective cross-sectional study with 49 eyes and 37 patients aged 10 to 50 years submitted to the CXL technique in 2017 at the Instituto Panamericano da Visão, in Goiânia, Goiás, Brazil. The Avedro KXL system was programmed in pulsed mode with interval (1/1 second), using 45 mW/cm² with 7.2 J and 0.25% riboflavin solution of Avedro with irradiated corneas for 8 minutes. Data were collected: sex, age, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), astigmatism, pachymetry at the thinnest point and keratometric astigmatism in the preoperative and postoperative periods at 1, 6 and 12 months. The Kolmogorov-Smirnov, Pearson's Chi-square, Friedman, Dunnett, and the Spearman correlation were used. Results: Twenty-three patients (62.2%) were female and 14 (37.8%) male. The mean age was 27.89 ± 10.89 years. The UDVA and CDVA significantly improved in the preoperative period in relation to 1 month (p = 0.01) and (p <0.001), 6 months (p <0.001 both) and 12 months (p <0.001 both). Astigmatism significantly reduced preoperatively in relation to 6 months (p = 0.02) and 12 months (p = 0.02). The pachymetry at the thinnest point remained constant in the period (p = 0.95). The difference between k2 and k1 (keratometric astigmatism) showed a significant reduction in the preoperative period in relation to 1 month (p = 0.01). Conclusion: The CXL technique was safe and effective in the treatment and stagnation of the disease in patients with progressive keratoconus.

Inativação fotodinâmica de bactérias patogênicas de interesse alimentar utilizando o fotossensibilizador protoporfirina IX / Photodynamic inactivation of pathogenic bacteria of food interest using the photosensibilizer protoporfirin IX

Salmonella enterica é um importante patógeno na indústria de alimentos, relacionado com gastroenterites alimentares. Staphylococcus aureus é causador de infecção intestinal. Neste cenário, a inativação fotodinâmica (IFD) surge como uma alternativa de desinfecção desses patógenos. A IFD consiste na interação de três elementos: um agente fotossensibilizador (FS) , luz e oxigênio molecular. Esta interação promove espécies reativas de oxigênio, causando danos irreparáveis à célula . Estes microrganismos possuem morfologia celular diversa, portanto uma concentração ideal de FS para cada cepa se faz necessária para o sucesso da técnica. O comprimento de onda absorvido pelo FS Protoporfirina IX corresponde ao vermelho do espectro eletromagnético (630 nm). Concentrações de 10 e 20 μM do pró-fármaco ácido aminolevulínico (ALA), observou-se a inativação de S. aureus em 20 μM, S. enterica manteve-se em crescimento. A IFD mostrou-se como uma promissora técnica para controle microbiano.

Comparison of apical periodontitis repair in endodontic treatment with calcium hydroxide-dressing and aPDT

Abstract This study evaluated the effect of antimicrobial photodynamic therapy (aPDT) on the endodontic treatment of apical periodontitis (AP). AP was induced in 48 premolars of 6 dogs. After biomechanical preparation, the teeth were divided into 4 groups: Calcium-Hydroxide (CH)/120d and CH/180d: root canals filled with CH-based dressing for 15 days before obturation; aPDT/120d and aPDT/180d: conditioning with phenothiazine photosensitizer (10 mg/mL) for 1 minute and irradiation with diode laser in the same session as obturation. Root filling was performed with AH Plus sealer. After the experimental periods, animals were euthanized and teeth were submitted for histology. HE staining was performed for descriptive analysis of the periapical region, measurement of apical periodontitis and for inflammatory cells, and blood vessels count. Immunohistochemistry was performed for osteopontin (OPN) and alkaline phosphatase (ALP). Data were analyzed statistically by two-way ANOVA and chi-square test (α = 5%). Teeth in Group CH/120d presented only a slightly enlarged periodontal ligament (PL) with advanced repair. Group aPDT/120d presented the PL moderately enlarged, with moderate inflammatory infiltrate and few collagen fibers. The same pattern was observed at 180 days. AP lesions in CH-treated groups were smaller than those in aPDT-treated groups (p < 0.001) with more blood vessels (p < 0.0001), regardless of the evaluation period, without significant differences in the number of inflammatory cells (p > 0.05). CH-treated groups showed significantly more intense immunostaining for ALP and OPN (p < 0.001) in both periods. Although aPDT stimulated angiogenesis and expression of bone formation markers, the two-session endodontic treatment with CH-based dressing promoted better apical periodontitis repair.

New strategies and developments for peri-implant disease

Abstract The aim of this illustrated review is to present the new strategies and developments to treatment and diagnosis of periimplant diseases. Periimplant disease is a subject of great concern for modern dentistry. The numbers of implant exhibiting biological complications grows as implant dentistry expands thought-out the world. Diagnosis and treatment of those diseases are still controversial and difficult. We present novel treatment for infection control and biological rationale of additional use of guided bone regeneration, with an illustrative explanation of the treatments presented with two cases.

A case series pilot study on the combination of 5-aminolevulinic acid and photodynamic therapy (ALA-PDT) for treatment of vitiligo

Abstract: Background: To study the effective therapeutic concentration, drug application duration, irradiation duration and irradiation dosage of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) for treating vitiligo and observe its clinical efficacy. Objective: To assess the clinical efficacy of ALA-PDT for treating vitiligo. Methods: ALA with different drug concentrations, drug application durations, irradiation durations and irradiation dosages were adopted to treat skin lesions caused by vitiligo to determine the effective drug concentration, drug application duration, irradiation duration and irradiation dosage for treating three vitiligo volunteers and observe the therapeutic results. Results: The clinical trial suggested that ALA at a drug concentration of 1.5%, drug application duration for 3 hours, irradiation dosage of 80mw/cm2 and irradiation duration for 20 min was effective in treating vitiligo. Under these parameters, ALA-PDT was effective to the three vitiligo volunteers, with mild pain and feeling of burning but no other adverse reaction during treatment. Study limitations: Due to the small sample size in this study for the effectiveness of PDT in treating vitiligo and the potential variations in the efficacy for treating the disease at different areas, further studies shall be conducted for confirmation. Conclusions: ALA with a drug concentration at 1.5%, drug application duration for 3 hours, irradiation dosage of 80 mw/cm2 and irradiation duration for 20 min is effective in treating vitiligo. Therefore, ALA-PDT is safe and effective in treating the disease, with minor adverse events, providing a new method for treating vitiligo in the future.

Blocking or enhancing effects of some basic emollients in UVA penetration

Abstract: Background: Topical agents used in combination with phototherapy or photochemotherapy may have both blocking or enhancing effects in ultraviolet rays. Objective: In this in vivo study, the effects of topical petrolatum, basis cream, glycerine, and olive oil on the transmission of ultraviolet A radiation were investigated. Methods: A test was performed to determine the minimal phototoxic dose on 29 volunteers with only psoralen plus ultraviolet A (PUVA) and then the same test was repeated with white petrolatum, basis cream, glycerine, olive oil, and sunscreen (0.3cc/25cm2). The effects of each agent on the minimal phototoxic dose were determined after 72 h. Results: When compared to pure PUVA, there was a statistically significant increase in the mean minimal phototoxic dose values by the application of white petrolatum (P = 0.011), but there was no significant increase or decrease in the mean minimal phototoxic dose values after the application of basis cream (P = 0.326), glycerine (P = 0.611) or olive oil (P = 0.799). Study limitations: Low number of patients Conclusion: The application of white petrolatum, which has a blocking effect, and also of basis cream immediately before PUVA therapy should not be recommended. Although we specify that glycerine and maybe olive oil can be used before photochemotherapy, there is a need for further research in larger series.

Osteoradionecrosis of the jaws: case series treated with adjuvant low-level laser therapy and antimicrobial photodynamic therapy

Abstract Background: Osteoradionecrosis of the jaw (ORNJ) is the most severe and complex sequel of head and neck radiotherapy (RT) because of the bone involved, it may cause pain, paresthesia, foul odor, fistulae with suppuration, need for extra oral communication and pathological fracture. We treated twenty lesions of ORNJ using low-level laser therapy (LLLT) and antimicrobial photodynamic therapy (aPDT). The objective of this study was to stimulate the affected area to homeostasis and to promote the healing of the oral mucosa. Methods: We performed aPDT on the exposed bone, while LLLT was performed around the bone exposure (red spectrum) and on the affected jaw (infrared spectrum). Monitoring and clinical intervention occurred weekly or biweekly for 2 years. Results: 100% of the sample presented clinical improvement, and 80% presented complete covering of the bone exposure by intact oral mucosa. Conclusion: LLLT and aPDT showed positive results as an adjuvant therapy to treat ORNJ.

Photodynamic action of the red laser on Propionibacterium acnes

Abstract: Background: Photodynamic therapy is a therapeutic modality that has consolidated its activity in the photooxidation of organic matter, which arises from the activity of reactive oxygen species. Objective: To evaluate the effect of red laser 660nm with the photosensitizer methylene blue on Propionibacterium acnes in vitro. Method: The experimental design was distributed into four groups (1 - control group without the application of light and without photosensitizer, 2 - application of light, 3 - methylene blue without light, and 4 - methylene blue with light). Tests were subjected to red laser irradiation 660nm by four cycles of 5 minutes at 3-minute intervals. Results: It was evidenced the prominence of the fourth cycle (20 minutes) groups 2, 3 and 4. Study limitations: Despite the favorable results, the laser irradiation time photosensitizer associated with methylene blue were not sufficient to to completely inhibit the proliferation of bacteria. Conclusion: Further studies in vitro are recommended to enable the clinical application of this photosensitizer in photodynamic therapy.

Effect of photodynamic therapy and non-thermal plasma on root canal filling: analysis of adhesion and sealer penetration

Abstract Objective The aim of this study was to evaluate the effect of photodynamic therapy (PDT) and non-thermal plasma (NTP) on adhesion and sealer penetration in root canals. Material and Methods Sixty single-rooted premolars were used. The teeth were prepared using a crown-down technique. NaOCl and EDTA were used for irrigation and smear layer removal, respectively. The root canals were divided into three groups: control, PDT, and NTP. After treatments, the roots were filled using gutta-percha and either AH Plus (AHP) or MTA Fillapex (MTAF) sealers. Samples were sectioned at 4, 8, and 12 mm from the apex (1-mm slices)and analyzed by the push-out bond strength test (adhesion) and confocal laser scanning microscopy (sealer penetration). Data were statistically evaluated using Kruskal-Wallis, Dunn's, and Spearman's tests. Results Regarding AHP, bond strength was similar in the NTP group and in the control group, but significantly lower in the PDT group. As to MTAF, both therapies showed lower values than the control group. In the confocal analysis of AHP, maximum and mean penetration, and penetrated area were statistically higher in the control group than in the PDT and NTP groups. Penetrated perimeter was similar among groups. Regarding MTAF, all parameters yielded better results in the NTP than in the control group. The PDT and control groups showed similar results except for penetrated area. Conclusion PDT and plasma therapy affected the adhesion and sealer penetration of root canals filled with AH Plus and MTA Fillapex and there is no positive correlation between adhesion and sealer penetration.

A new optical intra-tissue fiber irradiation ALA-PDT in the treatment of acne vulgaris in rabbit model: improved safety and tolerability

Abstract Background: Photodynamic therapy with topical aminolevulinic acid (ALA-PDT) has been suggested to be effective in treatment of acne vulgaris. However, adverse events occur during and after treatment. Objectives: To compare the efficacy and tolerability of optical intra-tissue fiber irradiation (OFI) ALA-PDT versus traditional ALA-PDT in treatment of acne vulgaris in rabbit models. Methods: Twenty-five rabbits of clean grade were used. Twenty rabbits were randomly selected to establish acne model and the other five were used as control. Rabbits in model group (40 ears) were further divided into four groups (10 ears/group): I, OFI-ALA-PDT with the head of optical fiber inserted into the target lesion (intra-tissue); II, traditional ALA-PDT group; III, OFI group; IV, blank control group without any treatment. Uncomfortable symptoms, adverse events, and effectiveness rates were recorded on post-treatment day 14, 30, and 45. Results: On post-treatment day 14, the effectiveness rate in OFI-ALA-PDT group was obviously higher than that of the other three groups (P<0.05). However, no improved effects were observed in OFI-ALA-PDT group on day 30 and 45. During the period of treatment, the frequencies of uncomfortable symptoms in ALA-PDT group were obviously higher than those in the other three groups (P<0.05). The adverse event rate in OFI-ALA-PDT group was obviously lower than that of the ALA-PDT group (P<0.05) Study limitations: The unblindness of the study and temporary animal models of acne induced may hamper the assessment and monitoring of the results, and future studies are still needed to clarify it further. Conclusion: The OFI-ALA-PDT group (intra-tissue irradiation) showed no improved efficacy on treating rabbit ear acne but had higher safety and better tolerability.

Daylight photodynamic therapy - Experience and safety in treatment of actinic keratoses of the face and scalp in low latitude and high brightness region

ABSTRACT Daylight photodynamic therapy has been used in countries with high latitudes during the summer for actinic keratoses treatment with reports of similar efficacy to conventional photodynamic therapy. We evaluate its safety in 20 patients in the city of Fortaleza, a local with low latitude and high brightness. Sixteen patients did not report any discomfort due to the procedure. Daylight photodynamic therapy is an easy application method with great tolerability by the patient and has the possibility of being performed throughout the year in these regions. It can mean a promising tool in the control of skin cancer.

Avaliação do recobrimento radicular pela técnica de enxerto conjuntivo subepitelial e condicionamento radicular com ácido cítrico associado à tetraciclina ou terapia fotodinâmica antimicrobiana - ensaio clínico randomizado / Analysis of root coverage by subepithelial connective tissue graft associated to root conditioning with citric acid plus tetracycline or antimicrobial photodynamic therapy ­ a randomized clinical trial

Este estudo teve o objetivo de comparar os efeitos da biomodificação radicular por ácido cítrico associado à tetraciclina (AC) ou terapia fotodinâmica antimicrobiana (aPDT) no recobrimento de recessões gengivais pela técnica do enxerto de tecido conjuntivo subepitelial (ETCS). Para o estudo paralelo foram selecionados 60 sítios em 17 pacientes com recessões de classe I e II de Miller de 2 a 5 mm, múltiplas e isoladas, as quais foram divididas em 3 grupos: grupo controle (C) - apenas raspagem, grupo AC ­ raspagem e, aplicação de gel de ácido cítrico associado à tetraciclina (90s) e o grupo aPDT - raspagem e aplicação da terapia fotodinâmica antimicrobiana (Azul de toluidina O 100µg/ml + laser vermelho). Os parâmetros clínicos profundidade de sondagem (PS), nível clínico de inserção (NCI), altura da recessão (AR), largura mucosa ceratinizada (LMC), espessura de mucosa ceratinizada (EMC), índice de sangramento à sondagem (ISS), índice de placa (IPI) e porcentagem de recobrimento radicular (%REC) foram avaliados por um examinador cego e calibrado no baseline e 3, 6 e 12 meses de pós-operatório. Avaliou-se a hiperestesia dentinária (HIPER) e a percepção estética (EST) do paciente através de escala analógica visual no baseline e após 7 e 14 dias e 1, 3, 6 e 12 meses. A análise estatística dos dados de NCI foi feita pelo teste ANOVA complementado por Tukey. O teste de Friedman complementado por Wilcoxon foi aplicado para análise intra-grupos. O teste de Kruskal-Wallis foi aplicado para as diferenças entre os grupos, complementado por comparações múltiplas entre os três grupos. Para a %REC foi realizado o teste de Kruskal-Wallis complementado por Dunnet (p<0,05). Observou-se ganho do NCI em todos os grupos, mas este ganho foi maior para os grupos AC (0,55±1,68) e aPDT (0,80±2,11) em relação ao C (2,50±1,99) (p<0,05). Houve redução na AR em todos os grupos, porém o grupo AC (0,40±0,62) teve maior redução quando comparado C (1,15±1,04) (p<0,05). Houve aumento na LMC em todos os grupos e aumento na EMC também em todos os grupos, sendo que a EMC nos grupos aPDT (2,80±0,733) e AC (2,33±0,60) foram iguais com melhores resultados que o C (1,99±0,65) (p<0,05). Para a PS não foram observadas diferenças significantes entre os grupos e nem entre os períodos (p>0,05). A %REC foi maior nos grupos AC (82%±30%) e aPDT (82%±28%) do que no grupo C (58%±40%) (p<0,05). De maneira geral C, AC e aPDT foram semelhantes entre si e entre eles ao longo do tempo para o ISS e IPI (p>0,05). Houve redução significante da HIPER ao longo do tempo e entre os grupos, sendo que em AC (1,20±2,23) e aPDT (0,70±1,15) a diminuição da sensibilidade foi maior do que em C (2,63±2,22) (p<0,05). Houve melhora na EST ao longo do tempo e para o grupo AC (9,40±0,96) foi maior do que o C (8,58±1,07) (p<0,05), sendo que o grupo aPDT foi igual ao C. Concluiu-se que o uso de biomodificadores radiculares, como o AC e aPDT favorecem o recobrimento de recessões, resultando em redução da hipersensibilidade dentinária, maior porcentagem de recobrimento radicular e mais sítios com recobrimento completo, mantendo os resultados a longo prazo. (AU)

The aim of this study was to compare root biomodification by a combination of citric acid with tetracycline (CA) or antimicrobial photodynamic therapy (aPDT) on root coverage by subepithelial connective tissue graft (SCTG). Sixty sites with Miller's class I or II recessions were divided in three groups: Control (C) ­ scaling only, CA ­ scaling and root conditioning with a combination of citric acid and tetracycline (gel ­ 90s), aPDT ­ scaling and antimicrobial photodynamic therapy (toluidine blue O 100 µg/ml and red laser). Periodontal clinical parameters as probing depth (PD), clinical attachment level (CAL), recession height (RH), keratinized mucosa height (KMH), keratinized mucosa width (KMW), bleeding on probing (BOP), plaque index (PI) and percentage of root coverage (%RC) were evaluated by a blinded calibrated examiner at baseline, 3, 6, 12 months. Dentinal hyperestesia (HYPER) and patient esthetic perception (EST) were recorded in a visual analogic scale at baseline, 7 and 14 days, 1, 3, 6,and 12 months. Statistical analysis of CAL values was done with ANOVA complemented by Tukey. Friedman's complemented by Wilcoxon's test evaluated intragroup data, while Kruskal-Wallis was applied for intergroup data. Comparison for %RC was done by Kruskal-Wallis complemented by Dunnet (p<0.05). Reduction in CAL was observed in all groups, with higher numbers for CA (0.55±1.68) and aPDT (0.80±2.11) in relation to C (2.50±1.99) (p<0.05). A higher reduction in RH was observed for CA (0.40±0.62) compared to C (1.15±1.04) (p<0.05). There was an improvement of KMH and KMW for all groups, but with higher values of KMW for aPDT (2.80±0.733) and CA (2.33±0.60) in relation to C (1.99±0.65) (p<0.05). There were no differences for PD (p>0.05). There was a significant higher %RC for CA (82%±30%) and aPDT (82%±28%) in relation to C (58%±40%) (p<0.05). In general, BOP and PI were similar for all groups and periods (p>0.05). There was a significant reduction in hyperestesia along time, but for CA (1.20±2.23) and aPDT (0.70±1.15) the reduction was higher than C (2.63±2.22) (p<0.05). Esthetic perception was improved along time with higher values for CA (9.40±0.96) than C (9.40±0.96) (p<0.05). In conclusion, root biomodification agents as CA and aPDT favored recession coverage by STCG, resulting in reduction of dentin hypersensitivity, higher percentage of root coverage and more sites with total coverage. Additionally, these results had a long-term stability. (AU)

Terapia fotodinámica como adyuvante en el tratamiento periodontal no quirúrgico: evaluación clínica / Photodynamic therapy as an adjuvant in nonsurgical periodontal treatment:A clinical evaluation

La terapia fotodinámica es considerada como un procedimiento no invasivo dentro de la práctica periodontal, reduciendo la morbilidad e incrementando la comodidad del paciente. Objetivo: el objetivo del presente estudio fue evaluar la eficacia clínica del uso de terapia fotodinámica como adyuvante al raspado y alisado radicular en periodontitis crónica. Material y métodos: se realizó un estudio comparativo, correlacional, aplicado a 20 pacientes con periodontitis crónica moderada-avanzada (pérdida de inserción clínica >- 6 mm) durante el raspado y alisado radicular no quirúrgico, con la adición de azul de metileno, donde se administró la terapia fotodinámica en dos sesiones, evaluando los parámetros clínicos (profundidad de bolsa, nivel de inserción clínico, índice de placa, sangrado al sondeo y recesión gingival). Resultados: tras cuatro semanas de evaluación postratamiento, no se observaron diferencias significativas en los parámetros clínicos entre el grupo experimental y control, aunque se encontró un mayor aumento de recesión gingival con el uso de la terapia fotodinámica (p=0,353). Conclusión: el uso de la terapia fotodinámica como adyuvante durante el raspado y alisado radicular convencional no proporciona beneficios adicionales al tratamiento periodontal convencional.

Photodynamic therapy is considered a non-invasiveprocedure in periodontal practice, one which reduces morbidity andincreases patient comfort. Objective: The aim of this study was toevaluate the clinical effi cacy of photodynamic therapy as an adjuvantto scaling and root planing in chronic periodontitis. Material andmethods: A comparative and correlational study was carried out on 20patients with moderate to advanced chronic periodontitis (attachmentloss ≥ 6 mm) during nonsurgical scaling and root planing, including theaddition of methylene blue. The photodynamic therapy was applied intwo sessions, during which the clinical parameters (pocket depth, clinicalattachment level, plaque index, bleeding on probing, and gingivalrecession) were assessed. Results: After four weeks of post-treatmentassessment, no signifi cant diff erences were found between the clinicalparameters of the experimental and control groups, although a greaterincrease in gingival recession was found when photodynamic therapywas used (p = 0.353). Conclusion: The use of photodynamic therapyas an adjuvant in conventional scaling and root planing provides noadditional benefi ts to conventional periodontal treatmen.