Photodisinfection: New treatment of periodontal infection

Photodisinfection: New treatment of periodontal infection

Periowave treatment kit

A number of innovative periodontal treatment options have been developed for use in the dental practice. These new modalities are often associated with novel technological approaches and functionally active chemistries that increase the predictability of treatment for the practitioner and the procedural comfort for the patient

 Indications for the Use of Photodisinfection

• With debridement for aggressive cases (instead of antibiotics) 

• With debridement (when purulence and generalized bleeding on probing are present)

• Refractory and recurrent cases of periodontitis

• Maintenance of difficult cases

• Disinfection of roots and furcation areas during regenerative surgery

• Disinfection of class II and III furcation involvement and deep vertical defects 

• Peri-implantitis treatment

CLINICAL OPTIONS FOR TREATING PERIODONTAL DISEASE

Traditionally, the treatment of periodontal diseases is composed of 2 distinct phases. 

The initial therapy, or nonsurgical phase, consists of procedures that are specifically designed to eliminate or control the various risk factors, which may contribute to chronic periodontitis. In this phase, dentists and their team: provide oral hygiene instruction and periodic reinforcement; perform supragingival and subgingival scaling and root planing to remove microbial plaque and calculus; treat or remove local irritation factors such as decay, overhangs, ill-contoured crowns, and misaligned teeth; and recommend the use of various antimicrobial agents as adjuncts to the above treatments. If the initial therapy does not significantly improve the periodontal condition, periodontal surgery is considered in order to help re­solve the disease process and/or assist in the correction of anatomic defects. A variety of surgical modalities may be appropriate in managing an individual patient. 

In selecting periodontal treatment modalities, the dental professional should closely examine each treatment alternative as a potential tool, and then decide which of these tools are best suited for a specific problem. A patient may benefit most from a “conservative” or nonsurgical approach in one quadrant, and a more “invasive” or surgical approach in another. From a clinical perspective, the critical determining factor is the treatment (or treatments) that will ultimately serve the patient best.

NONSURGICAL VERSUS SURGICAL PERIODONTAL TREATMENT :

As evidenced in the periodontal literature, the beneficial effects of scaling and root planing in the treatment of chronic periodontitis have been extensively studied and validated. The reduction of clinical inflammation, microbial shifts to a less pathogenic flora, decreased probing depth of periodontal pockets, a gain in the clinical attachment, and a diminished progression of disease, are amongst these benefits.

Generally, clinical soft-tissue conditions improve following nonsurgical treatment. However, some intraoral sites do not re­spond to this initial therapy and may benefit from a surgical approach. Surgical access can facilitate mechanical instrumentation of the roots, reduce probing depths significantly, and even regenerate or reconstruct lost periodontal tissues. Clinical trials indicate that both surgical and nonsurgical therapy approaches can effectively stabilize clinical attachment levels.

Each of these therapeutic modes has various advantages and drawbacks. A nonsurgical mechanical approach may be deemed more conservative. However, it may have limited efficacy in advanced diseased sites since it does not fully eliminate pathogenic bacteria from all infected areas; in particular, bacteria in deeper pockets and furcation areas. Flap reflection is considered more invasive, but can be more effective in increasing the clinician’s ability to debride the roots in these difficult areas. Osseous surgery has been shown to produce an even greater reduction of probing depths, but on the other hand, results in more extensive degrees of recession .

PERIOWAVE TREATMENT BRIEFLY DESCRIBED  

Periowave treatment is relatively simple to administer. However, there are certain rules that must be respected for maximal efficacy. It is essential to flood the periodontal pocket to be treated with adequate photosensitizing solution. Too little solution will affect the results negatively. The required irradiation time is one minute and must be respected. Too little time may compromise the photodynamic process. Each periodontal pocket must be treated individually. Results are better if the treated pocket is not bleeding profusely. Excessive bleeding can dilute the photosensitizing solution. If a patient is bleeding extensively after mechanical therapy, it is advisable to bring the patient back within one to 2 weeks for photodisinfection. Some tissue sites respond considerably better when treated photodynamically more than once .

For patients who had not previously received periodontal therapy, the combined use of nonsurgical mechanical therapy and photodisinfection results in a significant reduction of the clinical signs of inflammation. This includes suppuration, bleeding on probing, edema, and in the probing depths of pockets (particularly evident)  For these patients, it was noted that while the probing depths decreased considerably, soft-tissue re­cession was not significant

For patients who had previously received periodontal therapy (surgical and/or nonsurgical), but were still exhibiting signs of soft tissue deterioration, the combined use of nonsurgical mechanical therapy and photodisinfection displayed a lesser reduction of probing depths but a very significant reduction of bleeding on probing. Since the lack of bleeding on probing is one the few reliable indicators of disease stability, a decrease in the percentage of bleeding sites is a desirable outcome even when the changes in probing depths remain minimal .

Photodisinfection device