Photodynamic therapy and its impact on microbial load in periodontal pockets in aggressive periodontitis

Abstract

Introduction. Aggressive periodontitis is a rapidly progressive inflammatory and destructive disease of the periodontal tissues characterized by extensive alveolar bone resorption, a high microbial burden within periodontal pockets, and a rapidly evolving clinical course. Photodynamic therapy has emerged as a promising adjunctive approach owing to its potent local antimicrobial activity and its ability to reduce inflammatory responses. Aim. To evaluate changes in the microbial burden of periodontal pockets and assess the effectiveness of comprehensive treatment incorporating photodynamic therapy in patients with aggressive periodontitis. Materials and Methods. A prospective, randomized study was conducted involving 180 patients aged 17-35 years diagnosed with aggressive periodontitis. All participants received comprehensive treatment, including local and systemic antimicrobial therapy, professional mechanical plaque removal, dental calculus removal, root surface debridement using the Vector system, and adjunctive photodynamic therapy. Photodynamic treatment was performed using a chlorin e6-based photosensitizer followed by activation with a light-emitting diode laser operating at a wavelength of 625–635 nanometers. Microbiological evaluation was performed before treatment and at one and three months after therapy using light microscopy with Pappenheim panoptic staining. The sample size was calculated using G*Power version 3.1 with a statistical power of 80%. Results and Discussion. marked reduction in the microbial burden of periodontal pockets was observed as early as one month after treatment, with sustained improvement throughout the three-month follow-up period. The most pronounced therapeutic effect was demonstrated in patients aged 17–25 years with juvenile aggressive periodontitis, who exhibited a consistent reduction in microbial contamination at all follow-up assessments. Patients aged 26–35 years with rapidly progressive aggressive periodontitis also showed a decrease in microbial burden; however, the magnitude of improvement was less pronounced. These findings indicate that adjunctive photodynamic therapy significantly enhances the antimicrobial efficacy of comprehensive treatment for aggressive periodontitis. Conclusions. Photodynamic therapy significantly reduces the microbial burden of periodontal pockets for up to three months and demonstrates the greatest therapeutic benefit in younger patients with juvenile aggressive periodontitis