Single Session Of Antimicrobial Photodynamic Therapy Using Indocyanine Green

Effect of A Single Session Of Antimicrobial Photodynamic Therapy Using Indocyanine Green In The Treatment Of Chronic Periodontitis

In recent years, there has been a growing interest in the use of dental lasers for treatment of periodontal diseases. Commercially available photodynamic therapy for periodontal diseases utilizes methylene blue as a photosensitizer. In this study, the effects of a novel photosensitizer dye, indocyanine green (ICG), as an adjunct to nonsurgical treatment of chronic periodontitis will be evaluated.

Study Overview

• Status: Completed
• Conditions: Periodontitis
• Intervention / Treatment: Drug: indocyanine green; Device: LASER; Procedure: Scaling and Root Planing

Detailed Description

Background and objective: Periodontal disease is caused by periodontal pathogens that colonize the dental plaque and the subsequent host-microbial interactions. The recent years have witnessed a rapid increase in the usage of Light Amplification by Stimulated Emission of Radiation (Laser) in dentistry for the treatment of periodontal diseases. The additive therapeutic effects when a photoactivated dye such as methylene blue is used in conjunction with Laser is well documented. Indocyanine green (ICG), a tri-carbocyanine that belongs to family of cyanine dyes is widely used in the fields of Ophthalmology and Cardiac imaging. Recent in vitro studies have reported its efficacy in killing potent periodontal pathogens like A. actinomycetemcomitans and P. gingivalis when combined with 810 nm diode laser. The present study aims at evaluating the effects of ICG as an adjunct to non-surgical treatment of chronic periodontitis in biofilm environment of human periodontal pockets in terms of immediate reduction in percentage of viable bacteria and at the same to quantitatively assess host tissue injury. Methods: The study included 30 patients diagnosed with chronic periodontitis. Three sites from three different quadrants were selected and assigned to three groups namely, SRP group - scaling and root planing, LASER group - scaling and root planing with application of 810 nm diode laser and ICG group - scaling and root planing with application of 810 nm diode laser and ICG at a concentration of 5 mg/mL. Primary parameters included estimation of decrease in percentage of viable bacteria at baseline, immediate post treatment and end of 1 week and Lactate dehydrogenase (LDH) levels at baseline and end of 1 week. Secondary parameters included site-specific measures of plaque, gingivitis, pocket depth (PD) and clinical attachment loss (CAL) at specific time intervals.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Phase 2

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 30 years to 45 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

Patients who were diagnosed with chronic periodontitis having a clinical evidence of periodontal pocket of ≥5mm, in at least 4 sites in each of the 3 quadrants.

• Systemically healthy male & female patients within the age group of 35-55 years.
• No history of medications affecting the periodontium (antibiotics, immunosuppressive drugs, anti-inflammatory, anti-oxidants, antibiotic tooth paste, mouthwashes) or periodontal therapy in the past 24 weeks period leading to the study.

Materials & Methods 26

- Minimum of 5 teeth in each quadrant.

Exclusion Criteria:

Medically compromised patients.

• Patients who had received any antibiotic, periodontal or laser therapy during the past 24 weeks of base line examination.
• Patients using antibacterial mouth rinses or medicated tooth paste during the past 24 weeks.
• Patients with history of tobacco chewing, smoking and alcohol consumption.
• Pregnant women & lactating mothers.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: Double

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Indocyanine green (ICG); The study included 30 patients diagnosed with chronic periodontitis. Three sites from three different quadrants were selected and assigned to three groups namely, SRP group - scaling and root planing, LASER group - scaling and root planing with application of 810 nm diode laser and ICG group - scaling and root planing with application of 810 nm diode laser and ICG at a concentration of 5 mg/mL. Primary parameters included estimation of decrease in percentage of viable bacteria at baseline, immediate post treatment and end of 1 week and Lactate dehydrogenase (LDH) levels at baseline and end of 1 week. Secondary parameters included site-specific measures of plaque, gingivitis, pocket depth (PD) and clinical attachment loss (CAL) at specific time intervals.

Drug: indocyanine green; ICG group - scaling and root planing with application of 810 nm diode laser and ICG at a concentration of 5 mg/mL. Primary parameters included estimation of decrease in percentage of viable bacteria at baseline, immediate post treatment and end of 1 week and Lactate dehydrogenase (LDH) levels at baseline and end of 1 week. Secondary parameters included site-specific measures of plaque, gingivitis, pocket depth (PD) and clinical attachment loss (CAL) at specific time intervals.; Other Names: Cardiogreen; Photosensitizer; Device: LASER; LASER group - scaling and root planing with application of 810 nm diode laser Primary parameters included estimation of decrease in percentage of viable bacteria at baseline, immediate post treatment and end of 1 week and Lactate dehydrogenase (LDH) levels at baseline and end of 1 week. Secondary parameters included site-specific measures of plaque, gingivitis, pocket depth (PD) and clinical attachment loss (CAL) at specific time intervals.; Other Names: Diode LASER; Procedure: Scaling and Root Planing; SRP group - scaling and root planning. Primary parameters included estimation of decrease in percentage of viable bacteria at baseline, immediate post treatment and end of 1 week and Lactate dehydrogenase (LDH) levels at baseline and end of 1 week. Secondary parameters included site-specific measures of plaque, gingivitis, pocket depth (PD) and clinical attachment loss (CAL) at specific time intervals.; Other Names: Non-surgical Periodontal Therapy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Bacterial Vitality	Percentage of viable bacteria were estimated from the subgingival plaque samples at baseline, immediately after treatment and at the end of 1 week using a commercially available bacterial viability kit (LIVE/DEAD® BacLight™ Bacterial Viability Kit, Invitrogen, Leiden, The Netherlands).	Baseline to 1 week

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
LDH	LDH activity is used as an indicator of relative cell viability and plasma membrane integrity.,28 Quantitative total LDH was assayed by using a commercially available kit (LDH-Cytotoxicity Assay Kit II (Colorimetric) ®, Abcam, Cambridge, MA, USA). Initially, 10 μL of mammalian cell lysis solution (Cell Lysis Solution, Abcam, Cambridge, MA, USA) was added to every 100 μL of the GCF collected which was subsequently incubated at 30ºC for 5 minutes. The manufacturer's instructions were subsequently followed and the absorbance at 450nm background after subtracting the zero well/NADH background from all readings was recorded by using a colorimetric microplate reader (iMark™ Microplate Absorbance Reader, Bio-Rad, Hyderabad, India). The results are expressed as total LDH activity (mUnits/site) per sample where one unit LDH is the amount of enzyme that catalyzes the conversion of lactate to pyruvate to generate 1.0 μmol to NADH per minute at 37°C.	Baseline to 1 week

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Measures of Periodontal Health	Immediately after the laser application to the LASER group and 0.5 ml of 5mg/ml Indocyanine green dye along with laser to the ICG group by the second operator subgingival plaque samples were collected from the 3 sites by the first operator. The patients were recalled at the end of 1 week for collection of GCF and subgingival plaque samples for the assay of LDH levels and bacterial viability respectively. PI and MGI scores were recorded at the end of 1, 4, 12 and 24 weeks, while PD and CAL were recorded at the end of 12 and 24 weeks.	Baseline to Six months

Collaborators and Investigators

• Sponsor: SVS Institute of Dental Sciences
• Investigators: Study Chair: Sripriya Nagarajan, MDS, Svs Institute of Dental Sciences

Study record dates

Study Major Dates

• Study Start: October 1, 2012
• Primary Completion (Actual): July 1, 2013
• Study Completion (Actual): December 1, 2013

Study Registration Dates

• First Submitted: January 18, 2014
• First Submitted That Met QC Criteria: January 21, 2014
• First Posted (Estimate): January 23, 2014

Study Record Updates

• Last Update Posted (Estimate): January 23, 2014
• Last Update Submitted That Met QC Criteria: January 21, 2014
• Last Verified: January 1, 2014

More Information

Terms related to this study

• Keywords: Periodontitis; Indocyanine green; Scaling and root planing; Bacterial viability; Lactate dehydrogenase levels; Antimicrobial photodynamic therapy.
• Additional Relevant MeSH Terms: Stomatognathic Diseases; Periodontal Diseases; Mouth Diseases; Periodontitis; Dermatologic Agents; Photosensitizing Agents
• Other Study ID Numbers: SVS031102 (Other Identifier: Institutional ethics committee, SVSIDS)