Effect of photodynamic therapy with malachite green on non-surgical periodontal treatment in HIV patients : a pilot split-mouth study

Abstract

A number of oral lesions are among the early features of HIV infection. It has been described that HIV patients are at risk for severe periodontal diseases. In addition, there is a higher prevalence of periodontal pathogens such as Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and Tannerella forsythensis (Tf) in HIV patients compared with non-HIV patients. Polymerase chain reaction (PCR) is a diagnostic method that enables assessing microorganisms with very high levels of accuracy. For this reason, PCR is helpful to detect periodontal pathogens at levels below the ones detectable by cell culture or other diagnostic methods. In most cases, the sole use of repeated scaling and root planing (SRP) as periodontal therapy leads to satisfactory clinical outcomes. However, the aforementioned approach may not be enough to achieve periodontal health in more challenging cases, such as residual deep pockets and furcation areas . In addition, SRP often needs to be followed by adjunctive therapy such as local delivery and systemic antimicrobials and host modulation. One of the most recent methods used in combination with SRP in the periodontal treatment is the photodynamic therapy (PDT). In PDT, a photosensitizing agent is used to apply light therapy selectively to target specific cells. It is useful for sensitizing bacterial cells, leading to effective antimicrobial activity due to the production of cytotoxic oxygen free radicals (singlet oxygen). However, the efficacy of PDT is dependent on various factors, such as the laser wavelength and its interaction with the photosensitizer. One of the photosensitizers that have been used for the aforementioned purpose is the malachite green (MG), which leads to dissipation of the cell membrane potential in both gram-positive and - negative bacterial species. MG is defined as a cationic dye of the triarylmethane family that shows satisfactory absorption at the red end of the visible spectrum. However, little is known on the effect of PDT with MG as an adjunctive periodontal treatment in combination with SRP. Thus, the aim of this pilot split-mouth study was to assess clinical and microbiological effects of PDT with MG on non-surgical periodontal treatment in HIV patients.