Clinical and microbiological outcomes of photodynamic and systemic antimicrobial therapy in smokers with peri-implant inflammation

Aim: To compare the effectiveness of two protocols in the treatment of peri-implant mucositis (p-iM) among cigarette smokers. Materials and methods: Three groups were randomized into (i) single session of antimicrobial photodynamic therapy (aPDT) with mechanical debridement (MD) (Group-A), (ii) systemic AB with MD (Group-B), and (iii) MD alone (Group-C). Clinical peri-implant parameters including plaque scores (PS), bleeding on probing (BOP) and probing depth (PD) were measured at baseline, 6 weeks and 12 weeks. Microbiological parameters included the assessment of percentage level of Pseudomonas aeruginosa and Staphylococcus aureus at baseline and 12 weeks. All parameters were analyzed using Friedman test and multiple comparisons performed using Bonferroni tests. Pvalue less than 0.05 were considered statistically significant. Results: At 6 weeks of follow-up, there was a statistically significant reduction in PS (p <0.001), BOP (p<0.01), and PD (p<0.05) among patients in groups A and B on intragroup comparison. At 12 weeks of follow-up, there was a further significant reduction in PS (p<0.001) and BOP (p<0.01) among patients in groups A and B on intragroup comparison but this reduction was comparable with 6-week follow-up. On intergroup comparison, only Group-A showed statistically significant reduction in BOP compared to Group-B and C at 6 weeks (p<0.05). The levels of both P. aeruginosa and S. aureus in Group-A and Group-B showed statistically significant reductions at 12 weeks compared with baseline (p<0.01). On inter-group comparison, Group-A and B showed no significant differences at follow-up (p>0.05). Conclusion: This short term clinical study suggests that aPDT as an adjunct to MD is as efficacious as adjunctive antibiotic therapy. However, additional benefits in the reduction of bleeding scores were observed for aPDT in peri-implant inflammation among cigarette smokers.