Avaliação da terapia fotodinâmica antimicrobiana como terapia coadjuvante ao tratamento da periodontite em indivíduos com Síndrome de Down: estudo clínico controlado randomizado
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Data
2022-11-07
Autores
Petrilli, Pedro Henrique [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
A síndrome de Down (SD) é uma anomalia genética, do tipo extranumerária, caracterizada pela presença de um terceiro cromossomo de número 21 (Trissomia do 21), apresentando-se fenotipicamente com determinadas manifestações como: deficiência intelectual, alterações metabólicas, do sistema imune, e ainda, alterações na cavidade oral como macroglossia, oclusopatias, e maior susceptibilidade à Doença Periodontal (DP). A terapia periodontal tradicional visa reduzir a população e colonização bacteriana causadora das DPs, porém, em indivíduos com SD, tratamentos coadjuvantes eficazes se fazem necessários. A Terapia Fotodinâmica Antimicrobiana (aPDT) é uma modalidade de tratamento coadjuvante que tem se mostrado efetiva na redução e controle das bactérias periodontopatogênicas e estabilização da DP. O objetivo do presente estudo foi de avaliar o efeito de um protocolo de uma sessão de aPDT como terapia coadjuvante à raspagem e aplainamento radicular (RAR) para o tratamento da periodontite em indivíduos com SD. Foram recrutados 34 participantes, com SD e periodontite, os quais foram divididos, aleatoriamente em 2 grupos: Grupo RAR (n=17) receberam tratamento periodontal não-cirúrgico, através de instrumento ultrassônico e curetas periodontais; grupo RAR + aPDT (n=17), receberam tratamento periodontal e em, seguida aPDT como terapia coadjuvante nas bolsas com Profundidade de Sondagem (PS) ≥ 4 mm. O exame clínico periodontal foi realizado no início do estudo (baseline), aos 60 e aos 90 dias após o tratamento periodontal. Os seguintes parâmetros clínicos foram analisados: sangramento a sondagem (SS), profundidade de sondagem (PS) e nível de inserção clínica (NI). Os dados foram tabulados e submetidos a análise estatística com nível de significância de 5%. Na análise intergrupos, não foram observadas diferenças estatisticamente significantes para os parâmetros clínicos avaliados (p>0,05). Na análise intragrupo, houve redução significativa de SS no grupo RAR, quando comparados os três períodos avaliados. No grupo RAR + aPDT houve redução significante do SS aos 90 dias. No grupo RAR houve aumento significativo na porcentagem de sítios com PS ≤ 4mm nos períodos de 60 e 90 dias quando comparado ao baseline. No grupo RAR houve redução da porcentagem de sítios com NI 4-5 mm quando comparado baseline e 60 dias aos 90 dias. Concluiu-se que não houve benefícios clínicos adicionais com o protocolo utilizado em uma sessão de aPDT no tratamento da periodontite em indivíduos com SD, quando comparada a terapia convencional não cirúrgica.
Down syndrome (DS) is a genetic anomaly, of the supernumerary type, characterized by the presence of a third chromosome number 21 (Trisomy 21), presenting phenotypically with certain manifestations such as: intellectual disability, metabolic alterations, of the immune system, and also, alterations in the oral cavity such as macroglossia, malocclusions, and greater susceptibility to Periodontal Disease (PD). Traditional periodontal therapy aims to reduce the population and bacterial colonization that cause PDs, however, in individuals with DS, effective adjuvant treatments are necessary. Antimicrobial Photodynamic Therapy (aPDT) is an adjunctive treatment modality that has been shown to be effective in reducing and controlling periodontopathogenic bacteria and stabilizing PD. The aim of the present study was to evaluate the effect of a one-session aPDT protocol as adjunctive therapy to scaling and root planing (SRP) for the treatment of periodontitis in individuals with DS. Thirty-four participants were recruited, with DS and periodontitis, who were randomly divided into 2 groups: Group ARR (n=17) received non-surgical periodontal treatment, using an ultrasonic instrument and periodontal curettes; RAR + aPDT group (n=17) received periodontal treatment followed by aPDT as adjunctive therapy in pockets with Probing Depth (PS) ≥ 4 mm. Clinical periodontal examination was performed at baseline, 60 and 90 days after periodontal treatment. The following clinical parameters were analyzed: bleeding on probing (SS), probing depth (PS) and clinical attachment level (NI). Data were tabulated and submitted to statistical anaysis with a significance level of 5%. In the intergroup analysis, no statistically significant differences were observed for the evaluated clinical parameters (p>0.05). In the intragroup analysis, there was a significant reduction in SS in the ARR group, when the three periods evaluated were compared. In the RAR + aPDT group, there was a significant reduction in SS at 90 days. In the RAR group, there was a significant increase in the percentage of sites with PS ≤ 4mm in the periods of 60 and 90 days when compared to baseline. In the RAR group there was a reduction in the percentage of sites with NI 4-5 mm when compared to baseline and 60 days to 90 days. It was concluded that there were no additional clinical benefits with the protocol used in one session of aPDT in the treatment of periodontitis in individuals with DS, when compared to conventional non-surgical therapy.
Down syndrome (DS) is a genetic anomaly, of the supernumerary type, characterized by the presence of a third chromosome number 21 (Trisomy 21), presenting phenotypically with certain manifestations such as: intellectual disability, metabolic alterations, of the immune system, and also, alterations in the oral cavity such as macroglossia, malocclusions, and greater susceptibility to Periodontal Disease (PD). Traditional periodontal therapy aims to reduce the population and bacterial colonization that cause PDs, however, in individuals with DS, effective adjuvant treatments are necessary. Antimicrobial Photodynamic Therapy (aPDT) is an adjunctive treatment modality that has been shown to be effective in reducing and controlling periodontopathogenic bacteria and stabilizing PD. The aim of the present study was to evaluate the effect of a one-session aPDT protocol as adjunctive therapy to scaling and root planing (SRP) for the treatment of periodontitis in individuals with DS. Thirty-four participants were recruited, with DS and periodontitis, who were randomly divided into 2 groups: Group ARR (n=17) received non-surgical periodontal treatment, using an ultrasonic instrument and periodontal curettes; RAR + aPDT group (n=17) received periodontal treatment followed by aPDT as adjunctive therapy in pockets with Probing Depth (PS) ≥ 4 mm. Clinical periodontal examination was performed at baseline, 60 and 90 days after periodontal treatment. The following clinical parameters were analyzed: bleeding on probing (SS), probing depth (PS) and clinical attachment level (NI). Data were tabulated and submitted to statistical anaysis with a significance level of 5%. In the intergroup analysis, no statistically significant differences were observed for the evaluated clinical parameters (p>0.05). In the intragroup analysis, there was a significant reduction in SS in the ARR group, when the three periods evaluated were compared. In the RAR + aPDT group, there was a significant reduction in SS at 90 days. In the RAR group, there was a significant increase in the percentage of sites with PS ≤ 4mm in the periods of 60 and 90 days when compared to baseline. In the RAR group there was a reduction in the percentage of sites with NI 4-5 mm when compared to baseline and 60 days to 90 days. It was concluded that there were no additional clinical benefits with the protocol used in one session of aPDT in the treatment of periodontitis in individuals with DS, when compared to conventional non-surgical therapy.
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Palavras-chave
Síndrome de Down, Periodontite, Fotoquimioterapia, Periodontitis