Adjunctive methylene blue-based antimicrobial photodynamic therapy in the re-instrumentation of residual periodontal pockets in individuals with down syndrome: A randomized controlled clinical trial

Abstract

Objective: The aim of this study was to evaluate the use of a single session antimicrobial photodynamic therapy (aPDT) protocol in the re-instrumentation of residual periodontal pockets in individuals with Down Syndrome (DS).

Methods: 30 individuals with DS and stages I-III grade B periodontitis were allocated into the following groups: SI (n = 17): subgingival instrumentation (SI) in a single session; SI+aPDT (n = 17): SI in single session in residual pockets with probing depth (PD) ≥4 mm and bleeding on probing (BoP), methylene blue irrigation (100 µg/ml) after 60 s, and diode laser irradiation at 100 mW for 50 s. Periodontal clinical parameters PD, BoP, clinical attachment level (CAL) and immunological analysis interleukin (IL)-17, IL-1B, IL-6, IL-8 were evaluated at baseline and on 60 and 90 days. The clinical procedures performed in this study correspond to step 3 periodontal therapy, targeting residual periodontal pockets. All data were submitted to statistical analysis (α=5 %).

Results: A reduction in BoP was observed at 60 and 90 days in the SI+ aPDT group and in the SI group at 90 days. In the SI group, there was a significant reduction in the percentage of PD 4-5 mm at 90 days. Both groups showed a significant reduction in IL-17 levels on 60 and 90 days. The intergroup comparison has revealed no statistically significant differences.

Conclusion: The use of single session aPDT protocol by methylene blue as an adjuvant to non-surgical periodontal treatment in residual periodontal pockets does not promote additional clinical benefits in individuals with DS and periodontitis.

Clinical significance: The use of aPDT protocol with methylene blue in the re-instrumentation of residual periodontal pockets does not provide significant clinical advantages in individuals with stage I-III periodontitis and DS. These findings suggest that single-session aPDT may not enhance clinical or immunological outcomes beyond those achieved by conventional subgingival instrumentation alone during the step 3 of periodontal therapy.

Keywords: Antimicrobial photodynamic therapy; Down syndrome; Periodontitis.