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Home-Applied Dual-Light Photodynamic Therapy in the Treatment of Stable Chronic Periodontitis (HOPE-CP)—Three-Month Interim Results

Pakarinen S, Saarela RKT, Välimaa H, Heikkinen AM, Kankuri E, Noponen M, Alapulli H, Tervahartiala T, Räisänen IT, Sorsa T, Pätilä T. Home-Applied Dual-Light Photodynamic Therapy in the Treatment of Stable Chronic Periodontitis (HOPE-CP)—Three-Month Interim Results. 

Dentistry Journal. 2022; 10(11):206. https://doi.org/10.3390/dj10110206

Published: 2 November 2022

Abstract

A single-site, randomized clinical trial was designed to determine the efficacy of regular home use of Lumoral® dual-light antibacterial aPDT in periodontitis patients. For the study, 200 patients were randomized to receive non-surgical periodontal treatment (NSPT), including standardized hygiene instructions and electric toothbrush, scaling and root planing, or NSPT with adjunctive Lumoral® treatment. A complete clinical intraoral examination was conducted in the beginning, at three months, and at six months. This report presents the three-month results of the first 59 consecutive randomized subjects. At three months, bleeding on probing (BOP) was lower in the NSPT + Lumoral®-group than in the NSPT group (p = 0.045), and more patients in the NSPT + Lumoral®-group had their BOP below 10% (54% vs. 22%, respectively, p = 0.008). In addition, patients in the NSPT + Lumoral®-group improved their oral hygiene by visible-plaque-index (p = 0.0003), while the NSPT group showed no statistical improvement compared to the baseline. Both groups significantly reduced the number of deep periodontal pockets, but more patients with a reduction in their deep pocket number were found in the NSPT + Lumoral® group (92% vs. 63%, p = 0.02). Patients whose number of deep pockets was reduced by 50% or more were also more frequent in the NSPT + Lumoral®-group (71% vs. 33%, p = 0.01). Patients with initially less than ten deep pockets had fewer deep pockets at the three-month follow-up in the Lumoral® group (p = 0.01). In conclusion, adjunctive use of Lumoral® in NSPT results in improved treatment outcomes at three months post-therapy.
 

Indocyanine Green-Assisted and LED-Light-Activated Antibacterial Photodynamic Therapy Reduces Dental Plaque

Nikinmaa S, Meurman J, Moilanen N, Sorsa T, Rantala J, Alapulli H, Kankuri E, Kotiranta A, Auvinen P, Pätilä T. 

Dent. J. 20219(5), 52; https://doi.org/10.3390/dj9050052

The effects of indocyanine green-mediated photodynamic therapy on the development of plaque, plaque bacteriological ecology, and early periodontitis markers - A randomised study 

Introduction

Antimicrobial photodynamic therapy (aPDT) has been introduced as an adjunct method for dental hygiene. Although antibacterial and antiplaque effects resulting from aPDT have already been demonstrated in the literature, effects on bacterial flora diversity or early gingivitis biomarkers have not previously been established. 

Methods

Fifteen healthy adults were assigned to the study. Upper premolars (4. and 5.) were examined on both sides of the maxilla. After meticulous scaling and root planing, the maxillary dental arch was left without any mechanical cleaning for four days. Randomisation of the treatment side of the upper dental arch was performed, and following the initial sample collection, the mouth was rinsed with indocyanine green (ICG), and 100J/cm2 of 810 nm light was subsequently applied for eight minutes. The treatment was repeated daily for four days. ICG localisation after the mouth rinse procedure was measured after each treatment by near-infrared imaging. Plaque area, 16S rRNA bacteriological identification, and gingival crevicular fluid (GCF) matrix metalloproteinase 8 (MMP-8) samples were measured. Fluorescent imaging showed ICG adherence to dental plaque, enabling localised treatment at the target site.

Results

Antimicrobial photodynamic therapy resulted in a significant reduction of plaque formation. An analysis of the 16S rRNA sequencing found reduction in the Streptococcus, AcinetobacerialCapnocytophagal, and Rothia bacteria species and a gain in Neisseria and Hemophilus bacteria on the aPDT-treated side. The gain in the latter group of bacteria superseded the relative loss of the former in the plaque, while alpha diversity remained stable. A reduction of the total amount of MMP-8 in the GCF was seen on the treated side, suggesting inhibition of early gingivitis.

Conclusions

In conclusion, ICG -based aPDT is effective and reduces the amount of known oral pathogens, with compensated bacterial growth in species associated with good oral health, but without a change in overall bacterial diversity. The treatment can be applied specifically to dental plaque, and the anti-inflammatory effect may prevent the development of early gingivitis. 


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 and Timo Sorsa

Curr. Issues Mol. Biol. 202244(3), 1273-1283; https://doi.org/10.3390/cimb44030085

Published: 8 March 2022

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.

 

Sakari Nikinmaa, Anna Podonyi, Peter Raivio, Jukka Meurman, Timo Sorsa, Juha Rantala, Esko Kankuri, Tuomas Tauriainen and Tommi Pätilä 

Antibiotics 2021, 10, 1240. https:// doi.org/10.3390/antibiotics10101240

https://www.mdpi.com/1309944

Abstract

New means to reduce excessive antibiotic use are urgently needed. This study tested dual-light aPDT against Staphylococcus aureus biofilm with different relative ratios of light energy with indocyanine green. We applied single-light aPDT (810 nm aPDT, 405 aBL) or dual-light aPDT (simultaneous 810 nm aPDT and 405 nm aBL), in both cases, together with the ICG photosensitizer with constant energy of 100 or 200 J/cm2 . Single-dose light exposures were given after one-day, three-day, or six-day biofilm incubations. A repeated daily dose of identical light energy was applied during biofilm incubations for the three- and six-day biofilms. Using 100 J/cm2 light energy against the one-day biofilm, the dual-light aPDT consisting of more than half of aBL was the most effective. On a three-day maturated biofilm, single-dose exposure to aPDT or dual-light aPDT was more effective than aBL alone. With total light energy of 200 J/cm2 , all dual-light treatments were effective. Dual-light aPDT improves the bactericidal effect on Staphylococcus aureus biofilm compared to aPDT or aBL and provides a sustained effect. An increase in the relative ratio of aBL strengthens the antibacterial effect, mainly when the treatment is repeatedly applied. Thus, the light components’ energy ratio is essential with dual-light.


 

https://doi.org/10.18433/jpps32084

Journal of Pharmacy &Amp; Pharmaceutical Sciences, 24, 484–487.

Hentilä, J., Laakamaa, N., Sorsa, T., Meurman, J., Välimaa, H., Nikinmaa, S., Kankuri, E., Tauriainen, T., & Pätilä, T.

 

Purpose

During cancer treatment, oral mucositis due to radiotherapy or chemotherapy often leads to disruption of the oral mucosa, enabling microbes to invade bloodstream. Viridans streptococcal species are part of the healthy oral microbiota but can be frequently isolated from the blood of neutropenic patients. We have previously shown the antibacterial efficacy of dual-light, the combination of antibacterial blue light (aBL) and indocyanine green photodynamic therapy (aPDT).

 

Methods

Here, we investigated the dual-light antibacterial action against four-day Streptococcus oralis biofilm. In addition, while keeping the total radiant exposure constant at 100J/cm2, we investigated the effect of changing the different relative light energies of aBL and aPDT to the antibacterial potential.

 

Results

The dual-light had a significant antibacterial effect in all the tested combinations.

 

Conclusion

Dual-light can be used as an effective disinfectant against S. oralis biofilm.

 

Dual-light photodynamic therapy administered daily provides a sustained antibacterial effect on biofilm and prevents Streptococcus mutans adaptation

Sakari Nikinmaa, Heikki Alapulli, Petri Auvinen, Martti Vaara, Juha Rantala, Esko Kankuri, Timo Sorsa, Jukka Meurman, Tommi Pätilä

Published: May 6, 2020
https://doi.org/10.1371/journal.pone.0232775

Abstract

Antibacterial photodynamic therapy (aPDT) and antibacterial blue light (aBL) are emerging treatment methods auxiliary to mechanical debridement for periodontitis. APDT provided with near-infrared (NIR) light in conjunction with an indocyanine green (ICG) photosensitizer has shown efficacy in several dental in-office-treatment protocols. In this study, we tested Streptococcus mutans biofilm sensitivity to either aPDT, aBL or their combination dual-light aPDT (simultaneous aPDT and aBL) exposure. Biofilm was cultured by pipetting diluted Streptococcus mutans suspension with growth medium on the bottom of well plates. Either aPDT (810 nm) or aBL (405 nm) or a dual-light aPDT (simultaneous 810 nm aPDT and 405 nm aBL) was applied with an ICG photosensitizer in cases of aPDT or dual-light, while keeping the total given radiant exposure constant at 100 J/cm2. Single-dose light exposures were given after one-day or four-day biofilm incubations. Also, a model of daily treatment was provided by repeating the same light dose daily on four-day and fourteen-day biofilm incubations. Finally, the antibacterial action of the dual-light aPDT with different energy ratios of 810 nm and 405 nm of light were examined on the single-day and four-day biofilm protocols. At the end of each experiment the bacterial viability was assessed by colony-forming unit method. Separate samples were prepared for confocal 3D biofilm imaging. On a one-day biofilm, the dual-light aPDT was significantly more efficient than aBL or aPDT, although all modalities were bactericidal. On a four-day biofilm, a single exposure of aPDT or dual-light aPDT was more efficient than aBL, resulting in a four logarithmic scale reduction in bacterial counts. Surprisingly, when the same amount of aPDT was repeated daily on a four-day or a fourteen-day biofilm, bacterial viability improved significantly. A similar improvement in bacterial viability was observed after repetitive aBL application. This viability improvement was eliminated when dual-light aPDT was applied. By changing the 405 nm to 810 nm radiant exposure ratio in dual-light aPDT, the increase in aBL improved the antibacterial action when the biofilm was older. In conclusion, when aPDT is administered repeatedly to Smutans biofilm, a single wavelength-based aBL or aPDT leads to a significant biofilm adaptation and increased Smutans viability. The combined use of aBL light in synchrony with aPDT arrests the adaptation and provides significantly improved and sustained antibacterial efficacy.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232775

 

International Journal of Biomedical Imaging

A Review of Indocyanine Green Fluorescent Imaging in Surgery

International Journal of Biomedical Imaging  |  Volume 2012 Article ID 940585 | 26 pages | https://doi.org/10.1155/2012/940585

Jarmo T. Alander,1 Ilkka Kaartinen,2 Aki Laakso,3 Tommi Pätilä,4 Thomas Spillmann,5 Valery V. Tuchin,6,7,8 Maarit Venermo,9 and Petri Välisuo1

Academic Editor: Guowei Wei

Abstract

The purpose of this paper is to give an overview of the recent surgical intraoperational applications of indocyanine green fluorescence imaging methods, the basics of the technology, and instrumentation used. Well over 200 papers describing this technique in clinical setting are reviewed. In addition to the surgical applications, other recent medical applications of ICG are briefly examined.

Introduction

Fluorescence Imaging (FI) is one of the most popular imaging modes in biomedical sciences for the visualisation of cells and tissues both in vitro and in vivo [1]. The benefits of FI include

1. high contrast, that is, signal to noise ratio (SNR): only the target, not background, is visible because separate wavelengths are used for illumination and recording, 
2. high sensitivity: extremely small concentrations can often be made visible, 
3. Gives molecular information: makes some (bio) chemistry spatially and temporally visible, 
4. great tools for research: several possible imaging modes, most of which are unique, 
5. cheap: the optical instrumentation and computing needed are quite simple, 
6. easy to use: resembles classical staining.

Fluorescent imaging is a relatively recent imaging method and thus still developing in many ways. This is especially true for indocyanine green (ICG) imaging in its new clinical applications recently proposed in various branches of surgical medicine, although it has been used in some clinical applications routinely already for almost sixty years. Thus, ICG is well known in its established clinical applications, which greatly facilitates its introduction to new applications. From an engineering point of view, image and video processing seems to be among the main areas in which ICG imaging (ICGI) has potential for major developments, for example, for analysis of ICG fluorescence dynamics [2] (cf. Figure 2). This means, among other things, that a lot of computing development work is still needed for a broader acceptance of various emerging ICG-based medical imaging methods [3].

4.8.1. Photodynamic and Photothermal Therapy

When an ICG molecule is excited, it can further transfer energy to other molecules. When exciting oxygen, ICG turns out to be a photodynamic therapy agent. In principle, for example, after having been used to reveal lymph nodes a strong illumination with NIR light could be used to destroy metastatic nodes. ICG binds easily to tissue even at high concentrations, and the visual change in colour from green to orange is manifested by the wavelength shift in reflectance peak. ICG has been used in vitro laser-assisted fat cell destruction, which might give a new optics-based procedure for cosmetic surgery [239].

Similarly, ICGA can be used as a light-activated antibacterial agent (LAAA), for example, in wound healing [234], or treating chronic rhinosinusitis [240] with near-infrared laser illumination (NILI). It was shown recently that the photodynamic effect can be used for acne treatment [241243]. Nevertheless, many problems have to be solved in order to design optimal technology for acne treatment without side effects.

Through intense light (laser) irradiation a number of new effects can be provided, which lead to more effective bacteria killing and controllable cell destruction and/or inhibition of excessive synthesis of sebum in sebocytes, like the localised photodynamic effect based on the appropriate concentration of the suitable exogenous dye incorporated into hair follicle or any other skin appendages. The indocyanine green is one of the prospective exogenous dyes for soft photodynamic treatment (PDT).