Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2017 Antimicrobial photodynamic therapy as an adjunct for treatment of deep carious lesions: a systematic review Cieplik, Fabian ; Buchalla, Wolfgang ; Hellwig, Elmar ; Al-Ahmad, Ali ; Hiller, Karl-Anton ; Maisch, Tim ; Karygianni, Lamprini Abstract: For deep carious lesions, a more conservative treatment modality (”selective caries removal”) has been proposed, where only the heavily contaminated dentine is removed. In this regard, efective adjuncts for cavity disinfection such as the antimicrobial photodynamic therapy (aPDT) can be valuable clinically prior to defnitive restoration. Therefore, the aim of this study was to systematically assess clin- ical studies on the efectiveness of aPDT as a supplementary tool in the treatment of deep caries lesions. Searches were performed in four databases (PubMed, EMBASE, ISI Web of Science, ClinicalTrials.gov) from 1st January, 2011 until 21st June, 2016 for search terms relevant to the observed parameters, patho- logical condition, intervention and anatomic entity. The pooled information was evaluated according to PRISMA guidelines. At frst, 1651 articles were recovered, of which 1249 full-text articles were eval- uated, 270 articles thereof were reviewed for eligibility and fnally 6 articles met all inclusion criteria. The aPDT protocols involved Methylene Blue, Toluidine Blue and aluminium-chloride-phthalocyanine as photosensitizers and diode lasers, light-emitting diodes and halogen light-sources. The data from fve reports, utilizing both culture-dependent and -independent methods, disclosed signifcant reduction of cariogenic bacterial load after mechanical caries removal with adjunct aPDT. As these studies exhibit some methodological limitations, e.g. lack of positive controls, this systematic review can support the application of aPDT to a limited extent only in terms of reducing the microbial load in deep carious lesions before restorative treatment. DOI: https://doi.org/10.1016/j.pdpdt.2017.01.005 Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-143256 Journal Article Accepted Version Originally published at: Cieplik, Fabian; Buchalla, Wolfgang; Hellwig, Elmar; Al-Ahmad, Ali; Hiller, Karl-Anton; Maisch, Tim; Karygianni, Lamprini (2017). Antimicrobial photodynamic therapy as an adjunct for treatment of deep carious lesions: a systematic review. Photodiagnosis and Photodynamic Therapy, 18:54-62. DOI: https://doi.org/10.1016/j.pdpdt.2017.01.005
27
Embed
Antimicrobial photodynamic therapy as an adjunct for treatment … · 2020-04-09 · 1 1 Antimicrobial photodynamic therapy as an adjunct for 2 treatment of deep carious lesions –
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Zurich Open Repository andArchiveUniversity of ZurichMain LibraryStrickhofstrasse 39CH-8057 Zurichwww.zora.uzh.ch
Year: 2017
Antimicrobial photodynamic therapy as an adjunct for treatment of deepcarious lesions: a systematic review
Cieplik, Fabian ; Buchalla, Wolfgang ; Hellwig, Elmar ; Al-Ahmad, Ali ; Hiller, Karl-Anton ; Maisch,Tim ; Karygianni, Lamprini
Abstract: For deep carious lesions, a more conservative treatment modality (”selective caries removal”)has been proposed, where only the heavily contaminated dentine is removed. In this regard, effectiveadjuncts for cavity disinfection such as the antimicrobial photodynamic therapy (aPDT) can be valuableclinically prior to definitive restoration. Therefore, the aim of this study was to systematically assess clin-ical studies on the effectiveness of aPDT as a supplementary tool in the treatment of deep caries lesions.Searches were performed in four databases (PubMed, EMBASE, ISI Web of Science, ClinicalTrials.gov)from 1st January, 2011 until 21st June, 2016 for search terms relevant to the observed parameters, patho-logical condition, intervention and anatomic entity. The pooled information was evaluated according toPRISMA guidelines. At first, 1651 articles were recovered, of which 1249 full-text articles were eval-uated, 270 articles thereof were reviewed for eligibility and finally 6 articles met all inclusion criteria.The aPDT protocols involved Methylene Blue, Toluidine Blue and aluminium-chloride-phthalocyanineas photosensitizers and diode lasers, light-emitting diodes and halogen light-sources. The data from fivereports, utilizing both culture-dependent and -independent methods, disclosed significant reduction ofcariogenic bacterial load after mechanical caries removal with adjunct aPDT. As these studies exhibitsome methodological limitations, e.g. lack of positive controls, this systematic review can support theapplication of aPDT to a limited extent only in terms of reducing the microbial load in deep cariouslesions before restorative treatment.
DOI: https://doi.org/10.1016/j.pdpdt.2017.01.005
Posted at the Zurich Open Repository and Archive, University of ZurichZORA URL: https://doi.org/10.5167/uzh-143256Journal ArticleAccepted Version
Originally published at:Cieplik, Fabian; Buchalla, Wolfgang; Hellwig, Elmar; Al-Ahmad, Ali; Hiller, Karl-Anton; Maisch, Tim;Karygianni, Lamprini (2017). Antimicrobial photodynamic therapy as an adjunct for treatment of deepcarious lesions: a systematic review. Photodiagnosis and Photodynamic Therapy, 18:54-62.DOI: https://doi.org/10.1016/j.pdpdt.2017.01.005
1
Antimicrobial photodynamic therapy as an adjunct for 1
treatment of deep carious lesions – a systematic review 2
3
Fabian Cieplik1*, Wolfgang Buchalla1, Elmar Hellwig2, Ali Al-Ahmad2, Karl-4
Anton Hiller1, Tim Maisch3, Lamprini Karygianni2 5
6
1 Department of Conservative Dentistry and Periodontology, University Medical Center 7
Regensburg, Regensburg, Germany
8
2 Department of Operative Dentistry and Periodontology, Center for Dental Medicine, 9
University of Freiburg, Freiburg, Germany 10
3 Department of Dermatology, University Medical Center Regensburg, Regensburg, 11
Germany 12
13
14
15
Running title: aPDT as adjunct for treatment of deep carious lesions 16
17
Key words: deep carious lesions; caries treatment; antimicrobial; photodynamic; 18
aPDT 19
20
21
22
* Corresponding author: 23
Dr. Fabian Cieplik 24
Department of Conservative Dentistry and Periodontology 25
Küchler, N.L.P. Iorio, et al., Effect of the antimicrobial photodynamic therapy 620
on microorganism reduction in deep caries lesions: a systematic review and 621
meta-analysis, J. Biomed. Opt. 21 (2016) 90901. 622
doi:10.1117/1.JBO.21.9.090901. 623
[52] M.J. Wicht, R. Haak, H. Schütt-Gerowitt, S. Kneist, M.J. Noack, Suppression 624
of caries-related microorganisms in dentine lesions after short-term 625
chlorhexidine or antibiotic treatment, Caries Res. 38 (2004) 436–441. 626
doi:10.1159/000079624. 627
628
21
Table legends 629
Table 1 630
Overview of the authors, study design, number of subjects and treated teeth, type of 631
treatment, treatment groups, major outcomes and conclusions of the reviewed 632
studies on photodynamic therapy of cariogenic bacteria. 633
634
Table 2 635
Overview of the used PS, the light sources and the technical features with reference 636
to the aPDT devices as described in the reviewed studies. 637
638
Table 3 639
Overview of the number and type of treated teeth, cavity class and depth, 640
International Caries Detection and Assessment System (ICDAS) index, pulpal 641
involvement, symptoms and exclusion criteria as described in the reviewed ex vivo 642
studies on photodynamic therapy of cariogenic bacteria. 643
644
645
646
Figure legends 647
Figure 1 648
Flowchart of the search strategy as well as study selection and data management 649
procedure 650
Table 1
Authors
Year
Study
design
Number of subjects
/ treated teeth
Treatment groups /
Treatment type
Microbiological
methods
Main Outcomes Conclusions
[Guglielmi et
al., 2011]
in vivo 22 child patient / 26 teeth with carious lesions
Control group: no treatment Intervention group: Treatment with aPDT (laser irradiation + MB)
Culture method aPDT therapy yielded a significant CFU reduction of 0.91 log10 for total viable bacteria, 1.38 log10 for mutans streptococci, and 0.93 log10 for
Lactobacillus spp. compared to the control group.
aPDT was effective at
reducing the microbial loads
and has beneficial clinical
potential for the treatment of
deep carious lesions.
[Steiner-
Oliveira et al.,
2015]
in vivo 32 child patients /
32 teeth with carious
lesions
Control group: Treatment of carious dentine with 2 % CHX Intervention group: Treatment with aPDT (LED irradiation + TBO or laser irradiation + MB)
real-time PCR With the exception of
Streptococcus sobrinus the two
aPDT therapies induced a
significant reduction in total
bacterial content, Streptococcus
mutans, Lactobacillus casei,
Fusobacterium nucleatum and
Atopobium rimae.
No differences were detected
between the two aPDT protocols.
The two tested aPDT-
therapies may serve as
microinvasive strategies for
the effective treatment of
deep primary caries.
[Araújo et al.,
2015]
in vivo 10 child patients / 10 molars with deep active carious lesions
Control group: no treatment
(superficial and deep
dentine)
Intervention group: Treatment of superficial and deep dentine with
aPDT (halogen irradiation + MB)
Culture method
real-time PCR
Superficial dentine, deep dentine
directly and non-directly
irradiated: aPDT therapy allowed
for a significant CFU decrease of
2.5 ± 0.6, 1.9 ± 0.9 and 2.3 ± 0.8
log10 for total viable bacteria, 2.4
± 0.8, 2.2 ± 0.9 and 2.2 ± 0.9
log10 for streptococci, and 2.5 ±
0.7, 2.1 ± 1 and 2.0 ± 0.9 log10 for
Lactobacillus spp., respectively,
compared to the untreated
carious dentine.
Using conventional culture
methods, the effectiveness of
aPDT against all estimated
viable bacteria was
confirmed. However, real-
time PCR failed to detect
differences in regard to S.
mutans DNA content.
The maintenance of
superficial dentine had no
impact on aPDT outcomes in
deep dentine
Regarding S. mutans DNA
quantification by real-time PCR,
no differences between the
control and the aPDT-treated
groups were found.
[Neves et al.,
2016]
in vivo 19 child patients / 19 molars with
active carious lesions
Control group: no treatment
Intervention group:
Treatment with aPDT (laser
irradiation + MB)
Culture method
aPDT therapy resulted in a
statistically insignificant CFU
reduction of 0.61 log10 for total
viable bacteria, 0.44 log10 for
mutans streptococci, and 0.46
log10 for Lactobacillus spp.
compared to the untreated
carious lesions.
aPDT was not effective at
eliminating the viable
cariogenic microorganisms
and is therefore clinically
irrelevant for caries treatment
in deep dentine
[Melo et al.,
2015]
in vivo 45 adult patients /
90 teeth with carious
lesions
Control group: Treatment of carious dentine with 0.89 % NaCl
Intervention group:
Treatment with aPDT (LED
irradiation + TBO)
Culture method aPDT group showed a significant
CFU reduction of 1.07 log10 CFU,
while the control group showed a
CFU decrease of 0.47 log10.
After aPDT the bacterial count of
lactobacilli and mutans
streptococci reached the greatest
log10 reduction of 1.69 and 0.5
CFU, respectively, compared to
the control.
aPDT-treated dentine from
deep carious lesions yielded
a significant decrease in
cariogenic microbial load
[Longo et al.,
2012]
ex vivo / in
vivo
10 adult and child patients /
12 teeth with carious lesions
Control group: no treatment
Intervention group:
Treatment with aPDT (laser
irradiation + AlClPc)
Culture method After aPDT the bacterial count of
total cariogenic bacteria was reduced by 82% compared to the control.
aPDT was effective at
reducing the bacterial load
and thus allows for the
treatment of deep carious
lesions.
Table 2
Authors
Year
Light source
(peak
wavelength [nm])
PS (concentration
[µg/ml])
Optical fiber
diameter [µm]
Power output
[mW]
Energy fluence
[J/cm2]
Pre-irradiation /
irradiation period
[min]
Distance of
irradiation [mm]
[Guglielmi et al.,
2011]
low power diode
laser(InGaAIP -
Indium Gallium
Aluminum
Phosphide) (630
nm)
MB (Formula & Ação, Sao Paulo, Brazil) (100 µg/ml)
6000 µm
100 mW 320 J/cm2 5 min / 1.5 min 0.5 mm
[Steiner-Oliveira
et al., 2015]
red light-emitting
diode (LED, MM
Optics,São
Carlos-SP, Brazil)
(630 nm) / red
low power laser
(Photon Lase III-
DMC, São Carlos,
São Paulo, Brazil)
(630 nm)
TBO (100 µg/ml) / MB
(Chimiolux®-Hyrofarma,
BeloHorizonte, Minas
Gerais, Brazil) (100
µg/ml)
- LED: 100 mW
Laser: 100 mW
LED: 30 J/cm2
Laser: 320 J/cm2
LED: 1 min / 1 min
Laser: 5 min / 1.5 min
-
[Araújo et al.,
2015]
halogen light
curing unit (Curing
Light 3M Espe®,
3M Espe, USA)
(500-800 nm)
MB (Chimiolux®,
Aptivalux®, Belo
Horizonte, Brazil) (100
µg/ml)
-
260 mW
- 5 min / 1 min (with an
interval of 20 s
between two
applications of 30 s)
-
[Neves et al.,
2016]
low power diode
laser(InGaAIP -
Indium Gallium
Aluminum
MB (Chimiolux®,
Aptivalux®, Belo
Horizonte, Brazil) (100
µg/ml)
10000 µm 40 mW 120 J/cm2 5 min / 2 min 25 mm
Phosphide) (660
nm)
[Melo et al., 2015] red light-emitting
diode (LED, MM
Optics,São
Carlos-SP, Brazil)
(630 nm)
TBO (Sigma, St. Louis,
MO, USA) (100 µg/ml)
6000 µm
150 mW 94 J/cm2 5 min / - 2 mm
[Longo et al.,
2012]
red light-emitting
diode (LED, MM
Optics,São
Carlos-SP, Brazil)
(660 nm)
AlClPc (Aldrich Chemical Company, St. Louis, MO, USA)
(5 µM)
1200 µm 40 mW 180 J/cm2 5 min / 3 min -
TBO: toluidine blue ortho, MB: methylene blue, AlClPc: aluminum-chloride-phthalocyanine
Table 3
Authors
Year
Number /
type of
treated
teeth
Cavity
class
Cavity depth ICDAS
index
Pulpal
involvement /
Symptoms
Exclusion criteria
[Gugliel
mi et al.,
2011]
26
permanent
molars
Class I Deep carious lesions beyond the inner half of dentine
6 No / No - Use of antibiotics
within last 6 months
prior to study
- Irreversible pulp
inflammation
[Steiner-
Oliveira
et al.,
2015]
32 primary
molars
Class I Deep carious lesions extending to 2 / 3 of the inner half of dentine
6 Compatible with
reversible
pulpitis / No
- Use of antibiotics for
medical reasons
- Pain / Irreversible
pulp inflammation
- missed appointments
[Araújo
et al.,
2015]
10 molars Class I Deep carious lesions extending to 2 / 3 of the inner