The evaluation of efficiency of the photodynamic therapy in peri-implantitis

Abstract

Peri-implantitis is defined as an inflammatory process in the soft and hard tissue of surrounding osseointegrate implants in the function. The main aetiology factor in the development of the peri-implantitis is anaerobes, associated with the excessive immunological answer of the host, responsible for peri-implant tissue loss. Moreover, there are additional factors- general and local, which could promote development and progression of peri-implantitis. The subpopulation of Th lymphocytes such as Th1, Th2 and Th17 cells plays an important role in a pathogenesis of peri-impantitis. Different pro- and anti-inflammatory cells have been produced by an induced Th cell. Production and secretion of IL-17 are followed by the cascade interactions and activations of interleukins IL-1 β, IL-6, IL-21 and IL–23. IL-17 has an important role in different inflammatory diseases such as rheumatoid arthritis, periodontitis and peri-implantitis. The total amount of IL-17 is increased significantly in a peri-implant cervical fluid. Furthermore, differentiation of Th17 and secretion of IL-17 could have been induced by the microorganisms and their products such as Porphyromonas gingivitis. Synergistically, IL- 17 with IL-6 and IL-1β produced differentiation of osteoclasts, contributing directly or indirectly to osteoclastogenesis. The main goal of peri-implant therapy is a reduction of inflammation and creation of favourable conditions for the tissue repair and regeneration. Eradication of the causative bacteria and decontamination of the implant surface is essential in achieving predictable and stable clinical results. Photodynamic therapy (PDT) is a non-invasive adjuvant therapeutic method in the treatment of bacterial, viral and fungal infection. It is defined as an oxygen-dependent photochemical reaction that occurs upon light–mediated activation of a photosensitizing compound leading to the generation of cytotoxic reactive oxygen species, predominantly singlet oxygen. This reaction induces oxidative damage to the cell membrane and cell wall causing the death of cells. Objective The aim of this study was to evaluate clinical, immunological and microbiological outcomes of peri-implantitis when diverse surgical methods were used (with or without an adjunctive PDT). Methods Fifty-two diagnosed peri-implantitis sites were divided into two groups: experimental and control group. Before the surgical procedure, the initial- nonsurgical therapy followed by mechanical debridement of peri-implant pocket, was used in order to reduce the signs of inflammation...

Peri-implantitis se definiše kao inflamatorni proces koji zahvata pored mekih tkiva i potpornu kost oko oseointegrisanog implantata u funkciji. Osnovni etiološki faktor u razvoju peri-implantitisa su mikroorganizmi dentalnog plaka, koji udruženi sa ekstenzivnim imunim odgovorom domaćina dovode do gubitaka peri-implantnih tkiva. Pored glavnih etioloških faktora, brojni akcesorni faktori- opšti i lokalni, mogu da potspeše nastanak i progresiju peri-implantitisa. U patogenezi peri-implantnih oboljenja važnu ulogu imaju sve subpopulacije Th limfocita: Th1, Th2 i Th17 ćelije koje sekretuju različite pro- i anti-inflamatorne citokine. Produkcija i izlučivanje IL-17 praćena je kaskadnim reakcijama i međusobnim aktivacijama interleukina kao što su IL-1β, IL-6, IL-21 i IL-23. Značajna uloga IL-17 ogleda se u raznim inflamatornim oboljenjima kao što je reumatoidni artritis, parodontopatija i peri-implantitis. Značajno povišena koncentracija IL-17 detektovana je u periimplantnoj cervikalnoj tečnosti kod osoba sa dijagnostikovanim peri-implantitisom. Mikroorganizmi i njeni produkti kao što je Porphyromonas gingivalis, mogu da indukuju diferencijaciju Th17 ćelije i da omoguće produkciju IL-17. IL-17 ćelija uzajamnim dejstvom sa IL-6 i IL-1β sudeluju u diferencijaciji osteoklasta, uzrokujući indirektnu ili direktnu osteoklastogenezu. Osnovni cilj terapije peri-implantitisa je redukcija zapaljenja u peri-implantnom tkivu i stvaranje povoljnih uslova za reparaciju i regeneraciju zahvaćenih tkiva. Eliminacija patogenih mikroorganizama i dekontaminacija implantne površine predstavlja najbitniji korak u postizanju stabilnih kliničkih rezultata. Fotodinamska terapija (FDT), predstavlja novo pomoćno ne-invazivno terapijsko sredstvo u terapiji bakterijskih, virusnih i gljivičnih infekcija. Definiše se kao kiseonik-zavisna fotohemijska reakcija, koja nastaje aktivacijom fotoaktivne materije (engl. photosensitizer), pomoću svetlosti lasera niske talasne dužine (630 nm-700 nm) u prisustvu kiseonika. Izlaganjem fotodinamskog sredstva svetlosti lasera, dolazi do stvaranja slobodnih radikala i slobodnog kiseonika, prouzrokujući fotohemijsko oštećenje i smrt ćelije. Cilj rada bila je procena kliničkih, imunoloških i mikrobioloških parametara pre i 3 meseca nakon hirurške terapije, sa ili bez primene dodatne FDT. Metode rada. Implantati sa dijagnostikovanim peri-implantitisom (n = 52) bili su podeljeni u dve grupe: eksperimentalnu grupu (n=27) i kontrolnu grupu (n=25)...