Antibacterial photodynamic therapy

In the antibacterial photodynamic therapy (aPDT) , also photoactivated disinfection called, is a new in the dental used method to support the treatment of bacterial infections in periodontitis . As with photodynamic therapy in other specialist areas, light is used in combination with a light-activated substance, a so-called photosensitizer, and the presence of oxygen in the air .

According to the theory, PDT should primarily act against bacteria in biofilms , which conventionally used antibiotics can hardly penetrate. According to clinical phase I studies in a few patients, the method should possibly produce better results in the short term than the standard treatment alone ( debridement and root planing), but the differences were not always significant. It is recommended, however, to leave concretions unchanged, since bacterial recolonization will otherwise take place more quickly. Caries , infections of the oral cavity and peri-implantitis (infected dental implants ) are discussed as further possible areas of application . A current textbook for maxillofacial surgery recommends the use of wound healing disorders in bisphosphonate-associated bone necrosis .

Larger controlled studies or meta-analyzes are not available (as of 2014). Although the concept seems plausible, some questions remain unanswered. The scientific centers are reluctant to launch studies with large numbers of cases. Even if the data situation is promising, the devices and methods are not mature enough for a general application recommendation.

Procedure

Areas infected with bacteria, for example gum and bone pockets , wound surfaces or root canals are first professionally cleaned in order to remove the plaque and diseased tissue as best as possible. Then the biofilms in these areas and the inflammation-causing microorganisms contained are colored with the help of a special dye solution, the photosensitizer , and then exposed with a low-energy laser. The triggered photodynamic reaction leads to the formation of singlet oxygen (O ¹ ₂ ), an aggressive oxygen that destroys the bacterial wall and thus the bacterium.

The procedure is considered painless and free of side effects, as O ¹ ₂ diffuses only 0.1 µm and is extremely short-lived (10 ⁻⁹ seconds).

literature

• Michael R. Hamblin, Giulio Jori, Donat P. Hader (Eds.): Photodynamic Inactivation of Microbial Pathogens: Medical and Environmental Applications. Royal Society of Chemistry, 2011, ISBN 978-1-84973-144-7 .
• Rolfdieter Krause, Rainer Stange (Ed.): Light therapy. Springer-Verlag, 2012, ISBN 978-3-642-16939-7 .

Individual evidence

1. ↑ A. Taraszkiewicz, G. Fila u. a .: Innovative strategies in overcoming biofilm resistance. In: SM Abu Sayen: Biofilm Control and Antimicrobial Agents . CRC Press, 2014, ISBN 978-1-77188-002-2 , pp. 337-350 .
2. ^ S. Rajesh, E. Koshi et al. a .: Antimicrobial photodynamic therapy: An overview. In: Journal of Indian Society of Periodontology. Volume 15, number 4, October 2011, ISSN  0975-1580 , pp. 323-327, doi: 10.4103 / 0972-124X.92563 , PMID 22368354 , PMC 3283927 (free full text).
3. ^ ^{A b} Norbert Schwenzer, Michael Ehrenfeld: Oral and maxillofacial surgery . Georg Thieme Verlag, 2010, ISBN 978-3-13-163084-1 , p. 178 .
4. ↑ R. Malik, A. Manocha, DK Suresh: Photodynamic therapy-a strategic review. In: Indian journal of dental research: official publication of Indian Society for Dental Research. Volume 21, Number 2, 2010, ISSN  1998-3603 , pp. 285-291, doi: 10.4103 / 0970-9290.66659 , PMID 20657102 (review).
5. ↑ J. Pratten, V. Benhamou, C. Street: Antimicrobial photodynamic therapy (aPDT) for oral infections. In: Michael R. Hamblin, Giulio Jori, Donat P. Hader: Photodynamic Inactivation of Microbial Pathogens: Medical and Environmental Applications . Royal Society of Chemistry, 2011, ISBN 978-1-84973-144-7 , pp. 329-354 .

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