Wellman Center for Photomedicine, Massachusetts General Hospital and Harvard Medical School, 40 Blossom Street, Boston, Massachusetts 02114, United States.
Department of Restorative Dentistry, School of Dentistry, Araraquara, Sao Paulo State University─UNESP, 1680 Humaita Street, Araraquara, SP 14801-903, Brazil.
ACS Appl Mater Interfaces. 2023 Nov 1;15(43):50083-50094. doi: 10.1021/acsami.3c12820. Epub 2023 Oct 20.
Limited options exist for treatment of periodontitis; scaling and root planing (SRP) are not sufficient to eradicate and the resulting inflammatory disease. Chlorhexidine (CHX), used as an adjuvant to SRP, may reduce bacterial loads but leads to pain and staining, while evidence for its efficacy is lacking. Antibiotics are effective but can lead to drug-resistance. The rising concern of antibiotic resistance limits the future use of this treatment approach. This study evaluates the efficacy of a novel superhydrophobic (SH) antimicrobial photodynamic therapy (aPDT) device as an adjuvant to SRP for the treatment of periodontitis induced in a Wistar rat model relative to CHX. The SH-aPDT device comprises an SH silicone rubber strip coated with verteporfin photosensitizer (PS), sterilized, and secured onto a tapered plastic optical fiber tip connected to a red diode laser. The superhydrophobic polydimethylsiloxane (PDMS) strips were fabricated by using a novel soluble template method that creates a medical-grade elastomer with hierarchical surface roughness without the use of nanoparticles. Superhydrophobicity minimizes direct contact of the PS-coated surface with bacterial biofilms. Upon insertion of the device tip into the pocket and energizing the laser, the device generates singlet oxygen that effectively targets and eliminates bacteria within the periodontal pocket. SH-aPDT treatment using 125 J/cm of red light on three consecutive days reduced significantly more than SRP-CHX controls ( < 0.05). Clinical parameters significantly improved ( < 0.05), and histology and stereometry results demonstrated SH-aPDT to be the most effective treatment for improving healing and reducing inflammation, with an increase in fibroblast cells and extracellular matrix and a reduction in vascularization, inflammatory cells, and COX-2 expression. The SH-aPDT approach resulted in complete disease clearance assessed 30 days after treatment initiation with significant reduction of the periodontal pocket and re-formation of the junctional epithelium at the enamel-cementum junction. PS isolation on a SH strip minimizes the potential for bacteria to develop resistance, where the treatment may be aided by the oxygen supply retained within the SH surface.
牙周炎的治疗选择有限； 洁治和根面平整 (SRP) 不足以根除和由此产生的炎症性疾病。 作为 SRP 的辅助剂使用的洗必泰 (CHX) 可能会减少细菌负荷，但会导致疼痛和染色，而缺乏其疗效的证据。 抗生素有效，但会导致耐药性。 对抗生素耐药性的日益关注限制了这种治疗方法的未来应用。 本研究评估了一种新型超疏水 (SH) 抗菌光动力疗法 (aPDT) 设备作为 SRP 辅助治疗牙周炎的疗效，该设备在 Wistar 大鼠模型中诱导，与 CHX 相比。 SH-aPDT 设备包括涂有维替泊芬光敏剂 (PS) 的 SH 硅橡胶条，经过消毒，并固定在连接到红色二极管激光器的锥形塑料光纤尖端上。 超疏水聚二甲基硅氧烷 (PDMS) 条是通过使用新的可溶性模板方法制造的，该方法在不使用纳米颗粒的情况下创建具有分级表面粗糙度的医用级弹性体。 超疏水性将 PS 涂层表面与细菌生物膜的直接接触最小化。 将设备尖端插入口袋并给激光通电后，设备会产生单线态氧，有效地靶向并消除牙周袋内的细菌。 使用 125 J/cm 的红光连续三天进行 SH-aPDT 治疗可显著减少（<0.05）。 临床参数显著改善（<0.05），组织学和立体计量学结果表明，SH-aPDT 是改善愈合和减少炎症最有效的治疗方法，成纤维细胞和细胞外基质增加，血管化、炎症细胞和 COX-2 表达减少。 SH-aPDT 方法在治疗开始后 30 天评估时可实现完全疾病清除，牙周袋明显减少，牙釉质-牙骨质交界处的结合上皮重新形成。 PS 在 SH 带的隔离最大限度地减少了细菌产生耐药性的可能性，其中治疗可能会因 SH 表面保留的氧气供应而得到帮助。
