Repeated Home-Applied Dual-Light Antibacterial Photodynamic Therapy Can Reduce Plaque Burden, Inflammation, and aMMP-8 in Peri-Implant Disease-A Pilot Study

Hanna Lähteenmäki, Tommi Pätilä, Ismo T Räisänen, Esko Kankuri, Taina Tervahartiala, Timo Sorsa, Hanna Lähteenmäki, Tommi Pätilä, Ismo T Räisänen, Esko Kankuri, Taina Tervahartiala, Timo Sorsa

Abstract

Until now, in clinical dentistry, antibacterial photodynamic therapy (aPDT) has been restricted to in-office treatments, which hampers repeated applications. This pilot study tested the benefit of a commercially available Lumoral® device designed for regular periodontal dual-light aPDT treatment at home. Seven patients with peri-implant disease applied dual-light aPDT daily in addition to their normal dental hygiene for four weeks. A single Lumoral® treatment includes an indocyanine green mouth rinse followed by 40 J/cm2 radiant exposure to a combination of 810 nm and 405 nm light. A point-of-care analysis of active-matrix metalloproteinase (aMMP-8), visible plaque index (VPI), bleeding on probing (BOP), and peri-implant pocket depth (PPD) measurements was performed on day 0, day 15, and day 30. Reductions in aMMP-8 (p = 0.047), VPI (p = 0.03), and BOP (p = 0.03) were observed, and PPD was measured as being 1 mm lower in the implant (p = ns). These results suggest a benefit of regular application of dual-light aPDT in peri-implantitis. Frequently repeated application can be a promising approach to diminishing the microbial burden and to lowering the tissue destructive proteolytic and inflammatory load around dental implants. Further studies in larger populations are warranted to show the long-term benefits.

Keywords: aMMP-8; antibacterial photodynamic therapy; oral hygiene; peri-implant disease.

Conflict of interest statement

Timo Sorsa is the inventor of the following patents: 1274,416-patent U.S. 5,652,223, 5,736,341, 5,864,632, 6,143,476, and US 2017/0023571A1 (issued June 6, 2019); WO 2018/060553 A1 (issued May 31, 201); 10,488,415 B2, Japanese Patent 2016-554676; and South Korean patent 10-2016-7025378. Tommi Pätilä is a member of the board of Koite Health company. The company has filed patents P21233F100 and P22769F100 and owns trademarks related to antibacterial dual-light. Koite Health develops, sells, and markets dual-light antibacterial products for the prevention and treatment of dental and periodontal infections.

Figures

Figure 1
Figure 1
The dual-light aPDT device was used in the study. (A) The packaging provided for the study subjects included the effervescent ICG tablets (*) to be dissolved in 30 mL of water, for which a measuring cup (**) was provided. A power source (***) was provided for the mouthguard-type light applicator (B). The mouthpiece (*) is composed of 48 LED components (**) able to provide 405 nm and 810 nm light simultaneously. Symmetrically assembled LEDs provided light for both the maxillary and mandibular dental arches. The button on the control unit provided a treatment time of 10 min (***). Dissolved mouth rinse can be seen in the glass.
Figure 2
Figure 2
The power calculation.
Figure 3
Figure 3
The dots represent the measured individual values, the bars represent the mean, and the error bars are the standard error of the mean. (A) There was a reduction in aMMP-8 measured from PISF between the pretreatment and after four weeks of treatment. The red line represents the normal value in PISF measurements in implant patients. (B) After two weeks of single-use of the dual-light aPDT device, a suggestive reduction in VPI was measured. After the subsequent use of twice a day, VPI was significantly lower. (C) Bleeding on probing was positive in all study subjects at the beginning of the study. However, it was measured negative in three patients at four weeks. (D) One implant pocket showed a reduction in PD during the four-week study period.
Figure 4
Figure 4
This 89-year-old patient (A) showed buccal bone loss, assessed using an intraoral X-ray (B), and a gingival fistula at the study implant D13 (C). The visual plaque index measured 1/3 at the beginning of the study, with a probing depth of 4 mm. The aMMP-8 value in the peri-implant sulcular fluid was 78.18 ng/mL at the beginning of the study (D). After two weeks of Lumoral® dual-light aPDT treatment repeated once a day, the aMMP-value was 51.70 (D), after which the Lumoral® treatment was repeated twice a day for the next two weeks. At four weeks, the aMMP-8 was 23.76 ng/mL, and the visual plaque index measured 0/3. In this patient, bleeding on probing was measured positive though the whole study period, and no change was observed in the probing depth.

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