• Logo
  • SBMUJournals

Efficacy of Antimicrobial Photodynamic Therapy as an Adjunctive to Mechanical Debridement in the Treatment of Peri-Implant Diseases: A Randomized Controlled Clinical Trial

Mohammad Reza Karimi, Ali Hasani, Salva Khosroshahian




Introduction: The purpose of the present study was to assess the clinical effects of anti-microbial photodynamic therapy (PDT) after closed surface scaling in the treatment of peri-implant diseases.

Methods: Ten patients with a total of 15 pairs of dental implants, showing clinical and radiographic signs of peri-implant diseases, were included in this study. In each patient, one implant randomly served as control implant and the other served as test implant. The control implants were treated with closed surface scaling only and the test implants received additionally PDT, using light with a wavelength of 630 nm and intensity of 2000 mw/cm2 for 120 seconds after application of photosensitizer in peri-implant sulcus. Clinical parameters were evaluated before and 1.5 and 3 months after treatment.

Results: Statistical analysis showed significant differences in probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and gingival index (GI) at each time point between the two groups. There were no statistically significant changes with respect to any of the parameters in the control group. Complete resolution of BOP at 3 months was achieved in 100% of test implants. At 1.5 and 3 months, there were significant differences in the mean probing depth and CAL gain measurements at implants in the test group.

Conclusion: The present study revealed that adjunctive use of PDT following closed surface scaling could lead to clinical improvement of peri-implant diseases. Further studies are necessary to confirm our results


Clinical trial, Dental implant, Mechanical debridement, Peri-implantitis, Photodynamic therapy


Leonhardt A, Gröndahl K, Bergström G, Lekholm U. Long-term follow-up of osseointegrated titanium implants using clinical, radiographic and microbiological parameters. Clin Oral Implants Res. 2002;13(2):127-132. doi:10.1034/j.1600- 0501.2002.130202.x.

Takasaki A, Aoki A, Mizotani K, Schwarz F, Sculean A, Wang CY. Application of antimicrobial photodynamic therapy in periodontal and peri-implant diseases. Periodontol 2000. 2009;51:1–32. doi:10.1111/j.1600-0757.2009.00302.x.

Zitzmann NU, Berglundh T. Definition and prevalence of peri-implant diseases. J Clin Periodontal. 2008;35(Suppl. 8): 286-291. doi:10.1111/j.1600-051x.2008.01274.x.

Sahm N, Becker J, Santel T, Schwarz F. Non-surgical treatment of peri-implantitis using an air-abrasive device or mechanical debridement and local application of chlorhexidine: a prospective, randomized, controlled clinical study. J Clin Periodontol. 2011;38(9):872-878. doi:10.1111/j.1600-051x.2011.01762.x.

Shibli J, Melo L, Ferrari D, Figueiredo L, Faveri M, Feres M. Comparison of supra- and subgingival biofilm of subjects with healthy and diseased implants. Clin Oral Implants Res. 2008;19(10): 975-982. doi:10.1111/j.1600- 0501.2008.01566.x.

Zitzmann NU, Abrahamsson I, Berglundh T, Lindhe J. Soft tissue reactions to plaque formation at implant abutments with different surface topography. An experimental study in dogs. J Clin Periodontol. 2002;29(5):456-461. doi:10.1034/j.1600-051x.2002.290511.x.

Mombelli A. Microbiology and antimicrobial therapy of peri-implantitis. Periodontol 2000. 2002;28:177-189. doi:10.1034/j.1600-0757.2002.280107.x.

Parlor A, Bosshardt D, Cetiner D, et al. Effects of decontamination and implant surface characteristics on re-osseointegration following treatment of peri-implantitis. Clin Oral Implants Res. 2009;20(4):391-399. doi:10.1111/ j.1600-0501.2008.01655.x.

Karring E, Stavropoulos A, Ellegaard B, Karring T. Treatment of peri-implantitis by the Vector system. Clin Oral Implants Res. 2005;16(3):288-293. doi:10.1111/j.1600- 0501.2005.01141.x.

Porras R, Anderson G, Caffesse R, Narendran S, Trejo P. Clinical response to 2 different therapeutic regimens to treat peri-implant mucositis. J Periodontol. 2002;73(10): 1118-1125. doi:10.1902/jop.2002.73.10.1118.

Person L, Mouhji J, Berglundh T, Sennerby L, Lindhe J. Carbon dioxide laser and hydrogen peroxide conditioning in the treatment of periimplantitis: an experimental study in the dog. Clin Implant Dent Relat Res. 2004;6(4):230-238. doi:10.1111/j.1708-8208.2004.tb00039.x

Maximo M, de Mendonca A, Renata santos V, Figueiredo L, Feres M, Duarte P. Short-term clinical and microbiological evaluations of peri-implant diseases before and after mechanical anti-infective therapies. Clin Oral Implants Res. 2009;20(1):99-108. doi:10.1111/j.1600-0501.2008.01618.x.

Nociti F, Caffesse R, Sallum E, Machado M, Stefani C, Sallum A. Evaluation of guided bone regeneration and/ or bone grafts in the treatment of ligature-induced peri-implantitis defects: a morphometric study in dogs. J Oral Implantol. 2000;26(4):244-249.

Fürst M, Salvi GE, Lang NP, Persson GR. Bacterial colonization immediately after installation on oral titanium implants. Clin Oral Implants Res. 2007;18(4):501- 508. doi:10.1111/j.1600-0501.2007.01381.x.

Duarte PM, Reis AF, de Freitas PM, Ota-Tsuzuki C. Bacterial adhesion on smooth and rough titanium surfaces after treatment with different instruments. J Periodontol. 2009;80(11):1824-1832.

Kreisler M, Kohnen W, Christoffers AB, et al. In vitro evaluation of the biocompatibility of contaminated implant surfaces treated with an Er:YAG laser and an air powder system. Clin Oral Implants Res. 2005;16(1):36-43. doi:10.1111/j.1600-0501.2004.01056.x.

Duarte PM, Reis AF, de Freitas PM, Ota-Tsuzuki C. Bacterial adhesion on smooth and rough titanium surfaces after treatment with different instruments. J Periodontol. 2009;80(11):1824-32. doi:10.1902/jop.2009.090273.

Sigusch BW, Pfitzner A, Albrecht V, Glockmann E. Efficacy of phodynamic therapy on inflammatory signs and two selected periodontopathogenic species in a beagle dog model. J Periodontol. 2005;76(7):1100-1115. doi:10.1902/ jop.2005.76.7.1100.

Konopka K, Goslinski T. Photodynamic therapy in dentistry. J Dent Res. 2007;86(8):694-707. doi:10.1177/154405910708600803.

Pfitzner A, Sigusch BW, Albrecht V, Glockmann E. Killing of periodontopathogenic bacteria by photodynamic therapy. J Periodontol. 2004;75(10):1343-1349. doi:10.1902/ jop.2004.75.10.1343.

Chan Y, Lai CH. Bactericidal effects of different laser wavelengths on periodontopathic germs in photodynamic therapy. Lasers Med Sci. 2003;18(1):51-55. doi:10.1902/ jop.2004.75.10.1343.

Bhatti M, MacRobert A, Meghji S, Henderson B, Wilson M. A study of the uptake of toluidine blue O by Porphyromonas gingivalis and the mechanism of lethal photosensitization. Photochem Photobiol. 1998;68(3):370- 376. doi:10.1111/j.1751-1097.1998.tb09694.x.

Meisel P, Kocher T. Photodynamic therapy for periodontal diseases: State of the art. J Photochem Photobiol B. 2005; 79(2):159-70. doi:10.1016/j.jphotobiol.2004.11.023.

Haas R, Baron M, Dortbudak O, Watzek G. Lethal photosensitization, autogenous bone, and e-PTFE membrane for the treatment of peri-implantitis: preliminary results. Int J Oral Maxillofac Implants. 2000; 15(3):374-382.

Sarkar S, Wilson M. Lethal photosensitization of bacteria in subgingival plaque from patients with chronic periodontitis. J Periodontal Res. 1993;28(3):204-210. doi:10.1111/j.1600-0765.1993.tb01070.x.

Berglundh T, Lindhe J, Marinello C, Ericsson I, Liljenberg B. Soft tissue reaction to de novo plaque formation on implants and teeth. An experimental study in the dog. Clin Oral Implants Res. 1992;3(1):1- 8.

Berglundh T, Gislason O, Lekholm U, Sennerby L, Lindeh J. Histopathological observation on human peri implantitis lesions. J Clin Periodontol. 2004;31(5):341-347.

Konopka K, Goslinski T. Photodynamic therapy in dentistry. J Dent Res. 2007;86(8):694-707. doi:10.1177/154405910708600803.

Dortbudak O, Haas R, Bernhart T, Mailath-Pokorny G. Lethal photosensitization for decontamination of implant surfaces in the treatment of peri-implantitis. Clin Oral Implantants Res. 2001;12(2):104-108. doi:10.1034/j.1600- 0501.2001.012002104.x.

Hayek RR, Araujo NS, Gioso MA, et al. Comparative study between the effects of photodynamic therapy and conventional therapy on microbial reduction in ligature- induced peri-implantitis in dogs. J Periodontol. 2005;76(8):1275-1281.

Shibli JA, Martins M, Nociti F, Garcia V, Marcantonio E. Treatment of ligature-induced peri-implantitis by lethal photosensitization and guided bone regeneration: a preliminary study in dogs. J Periodontol. 2003;74(3):338– 345. doi:10.1902/jop.2003.74.3.338.

Haas R, Dörtbudak O, Mensdorff‐pouilly N, Mailath G. Elimination of bacteria on different implant surfaces through photosensitization and soft laser. An in vitro study. Clin Oral Implants Res. 2002;8(4):249-254. doi:10.1034/ j.1600-0501.1997.080401.x.

Schwarz F, Sahm N, Iglhaut G, Becker J. Impact of the method of surface debridement and decontamination on the clinical outcome following combined surgical therapy of peri-implantitis: a randomized controlled clinical study. J Clin Periodontol. 2011;38(3):276-284.

Renvert S, Samuelsson E, Lindahl C, Persson GR. Mechanical non-surgical treatment of peri-implantitis: a double-blind randomized longitudinal clinical study. I: Clinical results. J Clin Periodontol. 2009;36(7):604-609.

Renvert S, Lessem J, Dahlén G, Renvert H, Lindhal C. Mechanical and repeated antimicrobial therapy using a local drug delivery system in the treatment of peri-implantitis: a randomized clinical trial. J Periodontol. 2008; 79(5):836-844.

Salvi G, Persson G, Heitz-Mayfield L, Frei M, Lang N. Adjunctive local antibiotic therapy in the treatment of peri-implantitis ll: clinical and radiographic outcome. Clin Oral Implants Res. 2007;18(3):281-285.

Persson GR, Samuelsson E, Lindahl C, Renvert S. Mechanical non-surgical treatment of peri-implantitis: a single-blinded randomized longitudinal clinical study. II. Microbiological results. J Clin Periodontol. 2010;37(6):563- 573. doi:10.1111/j.1600-051x.2010.01561.x.

Salvi GE, Fürt MM, Lang NP, Persson GR. One-year bacterial colonization patterns of staphylococcus aureus and other bacteria at implants and adjacent teeth. Clin Oral Implants Res. 2008;19(3):242-248. doi:10.1111/j.1600- 0501.2007.01470.x.

Gerber JA, Tan WC, Balmer TE, Salvi GE, Lang NP. Bleeding on probing and pocket probing depth in relation to probing pressure and mucosal health around oral implants. Clin Oral Implants Res. 2009;20(1):75-78. doi:10.1111/j.1600- 0501.2008.01601.x.

Gosau M, Habnel M, Schwarz F, Gerlach T, Reichert T, Bürgers R. Effect of six different peri-implantitis disinfection methods on invivo human oral biofilm. Clin Oral Implants Res. 2010;21(8):866-872. doi:10.1111/j.1600- 0501.2009.01908.x.

Kotsoovilis S, Karoussis I, Trianti M, Fourmousis I. Therapy of peri-implantitis: a systemic review. J Clin Periodontol. 2008;35(7):621-629. doi:10.1111/j.1600- 051x.2008.01240.x.

DOI: https://doi.org/10.22037/jlms.v7i3.9337