Theodoro Leticia Helena, Rodrigues João Victor Soares, Cláudio Marina Modolo, Sant'Ana Amanda Paino, Mulinari-Santos Gabriel, Wainwright Mark, Casarin Renato Correa Viana, de Molon Rafael Scaf, Garcia Valdir Gouveia
Department of Diagnostic and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil; Center for Dental Assistance to Persons with Disabilities (CAOE), School of Dentistry, Araçatuba, São Paulo, Brazil.
Department of Diagnostic and Surgery, São Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil; Center for Dental Assistance to Persons with Disabilities (CAOE), School of Dentistry, Araçatuba, São Paulo, Brazil.
J Dent. 2025 Aug 25:106060. doi: 10.1016/j.jdent.2025.106060.
We sought to evaluate the photodynamic effect of butyl toluidine blue (BuTB) as an adjuvant therapy for the treatment of residual periodontal pockets in patients with type 2 diabetes mellitus (DM2).
This randomized clinical study comprised 42 DM2 patients with residual periodontal pockets, defined as probing pocket depth (PPD) ≥ 4 mm and bleeding on probing (BOP). Subjects were assigned to one of the following groups: Subgingival instrumentation (SI): SI performed in a single session; and SI + antimicrobial photodynamic therapy (aPDT): SI in a single session, followed by pocket irrigation with BuTB and irradiation with a 660 nm diode laser at 100 mW for 50s. Periodontal clinical parameters, glycated hemoglobin levels, and immunological markers in crevicular fluid were assessed at baseline, and after 90 and 180 days.
A total of 30 patients completed the study follow-up. Clinically, both groups showed improvements in periodontal parameters over time. The SI + aPDT group exhibited a significantly higher percentage of closed pockets (PPD ≤ 3 mm) and a lower percentage of moderate or deep pockets (PPD ≥ 4 mm) at 90 and 180 days compared to the SI group. BOP was significantly lower in the SI + aPDT group at baseline and 90 days. A reduction in PPD ≥ 4 mm and a gain in CAL were observed at both 90 and 180 days in both groups compared to baseline. In the intergroup analysis, the SI + aPDT group showed a greater reduction in PPD ≥ 4 mm at 90 and 180 days, as well as a significantly improved CAL gain at 90 days compared to the SI group (p < 0.05). No significant differences were observed between groups in immunological biomarkers (90 days period).
Both treatment approaches improved periodontal parameters over time. However, the adjunctive use of BuTB-mediated aPDT with SI led to a significantly higher percentage of closed pockets (PPD ≤ 3 mm) and a lower proportion of persistent residual pockets (PPD ≥ 4 mm), indicating a more favorable clinical response in the test group.
Local adjuvant therapy, such as aPDT, in the treatment of residual periodontal pockets may reduce the need for future surgical interventions and retreatment in patients with uncontrolled DM2.
我们旨在评估丁基甲苯胺蓝（BuTB）作为辅助治疗手段对2型糖尿病（DM2）患者残留牙周袋的光动力效应。
这项随机临床研究纳入了42例有残留牙周袋的DM2患者，残留牙周袋定义为探诊深度（PPD）≥4 mm且探诊出血（BOP）。受试者被分配到以下组之一：龈下器械治疗（SI）组：单次进行龈下器械治疗；SI + 抗菌光动力疗法（aPDT）组：单次进行龈下器械治疗，随后用BuTB进行牙周袋冲洗，并用100 mW的660 nm二极管激光照射50秒。在基线、90天和180天后评估牙周临床参数、糖化血红蛋白水平和龈沟液中的免疫标志物。
共有30例患者完成了研究随访。临床上，两组的牙周参数均随时间有所改善。与SI组相比，SI + aPDT组在90天和180天时表现出明显更高的牙周袋闭合率（PPD≤3 mm）和更低的中度或深度牙周袋（PPD≥4 mm）比例。SI + aPDT组在基线和90天时的BOP明显更低。与基线相比，两组在90天和180天时均观察到PPD≥4 mm的减少和临床附着丧失（CAL）的增加。在组间分析中，与SI组相比，SI + aPDT组在90天和180天时PPD≥4 mm的减少幅度更大，且在90天时CAL增加明显改善（p < 0.05）。两组在免疫生物标志物方面（90天期间）未观察到显著差异。
两种治疗方法均随时间改善了牙周参数。然而，BuTB介导的aPDT与SI联合使用导致明显更高的牙周袋闭合率（PPD≤3 mm）和更低比例的持续性残留牙周袋（PPD≥4 mm），表明试验组有更有利的临床反应。
局部辅助治疗，如aPDT，在治疗残留牙周袋时可能会减少未控制的DM2患者未来手术干预和再治疗的需求。
