Name: adjunctive diode laser therapy and probiotic lactobacillus therapy in the treatment of periodontitis and peri-implant disease
Uploaded: 2022-05-09T14:00:00.000+00:00
Duration: 6 min 6 s
Description: Watch this Scientific Journal Video about Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease at JoVE.com

This work was supported by the National Natural Science Foundation of China (grant numbers 82071078, 81870798, and 82170927).

This study was approved by the Institutional Review Board of the College of Stomatology, Xi&#39;an Jiaotong University (xjkqll[2022]NO.034). Informed consent was available from the patients involved in this study.
1. Adjunctive diode laser therapy in the non-surgical treatment of periodontitis
<ol>
	<li>Eligibility criteria
	<ol>
		<li>Use the following inclusion criteria: age &#8805; 18 years; probing pocket depth (PPD) &#8805; 5 mm; detectable clinical attachment loss (CAL) and radiographic bone loss (RBL).</li>
		<li>Use the following exclusion criteria: patients with systematic diseases or under medication that may affect the inflammation and healing process; patients who had received periodontal treatment within 6 months; smokers or alcoholics; pregnant or lactating patients; periodontal-endodontic combined lesions; class III tooth mobility.</li>
	</ol>
	</li>
	<li>Clinical examination
	<ol>
		<li>Measure full-mouth PPD, bleeding on probing (BOP) at six sites per tooth (i.e., mesiobuccal, buccal, distobuccal, distolingual, lingual, and mesiolingual), and mobility of each tooth, excluding third molars. Measure CAL for teeth with PPD &#8805; 5 mm. Detect the cementoenamel junction by probing to calculate the CAL.</li>
		<li>Record the baseline parameters on a periodontal chart (Supplementary File 1).</li>
	</ol>
	</li>
	<li>Disinfection and anesthesia
	<ol>
		<li>Gargle with 3% hydrogen peroxide for 1 min, followed by pure water. Disinfect the operating area with 1% iodophor. Administer a local injection of primacaine adrenaline for anesthesia.</li>
	</ol>
	</li>
	<li>Mechanical debridement by scaling and root planing (SRP) 
	NOTE: SRP is necessary for treating periodontitis including ultrasonic or manual cleaning. Dental scaling removes the plaque and calculus from the surface of the tooth above and below the gumline. Root planing usually follows dental scaling and attempts to smooth out the rough surface of the root and helps the gums to reattach to the teeth.
	<ol>
		<li>Firstly, use an ultrasonic device to perform SRP for teeth with PPD &#62; 3 mm. Secondly, use hand-held instruments (Gracey curettes 5/6, 7/8, 11/12, and 13/14) to perform SRP for teeth with PPD &#62; 3 mm (Figure 1). Thirdly, use an ultrasonic device to perform SRP for these teeth a second time. 
		NOTE: The diode laser alone is not effective in eliminating calculus, so a thorough SRP cannot be omitted. If the patient has a large number of affected teeth, only one quadrant can be treated at each appointment. The ultrasonic and manual SRP can be performed within 1-4 appointments.</li>
		<li>Rinse the periodontal pockets with 3% hydrogen peroxide and gargle with pure water.</li>
		<li>Apply polishing paste to the teeth surface, polish the full-mouth teeth surfaces using a low-speed handpiece with a rubber cap, and then gargle with pure water.</li>
	</ol>
	</li>
	<li>Adjunctive diode laser therapy 
	NOTE: Choose teeth with PPD &#8805; 5 mm for laser treatment. Choose one of the following two usage modes (i.e., steps 1.5.1 or 1.5.2).
	<ol>
		<li>Inside pocket laser irradiation (only one session of laser appointment per tooth is suggested) (Figure 2A).
		<ol>
			<li>Ensure that both the operator and patient wear protective goggles to protect the eyes from laser damage.</li>
			<li>Prepare the diode laser device (wavelength = 980 nm, output power = 1 W, power density = 1414.7 W/cm2, continuous wave, 300 &#181;m fiber optic delivery system). 
			NOTE: Improperly increasing the power may cause thermal damage; please consult the laser manufacturer and follow the manufacturer&#39;s instructions before use.</li>
			<li>Calibrate the length of the fiber tip exposed to 1 mm less than the measured PPD (Figure 2B). 
			NOTE: To prevent bleeding due to the insertion of the fiber tip too deep into the periodontal pocket, it is generally recommended that the exposed fiber tip length is 1 mm less than the measured periodontal pocket depth.</li>
			<li>Gently insert the fiber tip into the periodontal pocket 1 mm less than the measured PPD, and slowly sweep the tip both in mesial-distal and apical-coronal directions for 30 s per tooth (Figure 2B,C). 
			NOTE: During this process, inserting the fiber too deeply into the periodontal pocket can irritate periodontal bleeding and thus prevent the laser from acting. Remove the granulation attached to the fiber tip using a cotton ball containing 75% alcohol to avoid jeopardizing the laser effectiveness.</li>
		</ol>
		</li>
		<li>Outside pocket laser irradiation (a total of 3-5 sessions of laser appointments per tooth is suggested) (Figure 3A).
		<ol>
			<li>Ensure that both the operator and patient wear protective goggles to protect the eyes from laser damage.</li>
			<li>Prepare the diode laser device (wavelength = 980 nm, output power = 0.4 W, power density = 566.2 W/cm2, continuous wave, 300 &#181;m fiber optic delivery system).</li>
			<li>Irradiate the gingival surface of the pocket for approximately 15 s per pocket, with the laser fiber tip 5 mm (2-10 mm) away from the gingival surface and directed at an angle of 90&#176; (Figure 3B,C).</li>
			<li>Repeat the same outside pocket laser treatment after 1, 3, 5, and 7 days.</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Give oral hygiene instruction (OHI) to each patient, including Bass brushing technique, interdental floss, and brush19.</li>
	<li>Clinical examination
	<ol>
		<li>Measure the PPD, CAL, and BOP for each tooth 4-6 weeks, 3 months, and 6 months after periodontal treatment. Record the postoperative parameters on a new periodontal chart (Supplementary File 1).</li>
		<li>Compare the baseline and postoperative parameters.</li>
	</ol>
	</li>
</ol>
2. Adjunctive probiotic therapy in the nonsurgical treatment of peri-implant mucositis (Figure 4A)
<ol>
	<li>Eligibility criteria
	<ol>
		<li>Use the following inclusion criteria: age &#8805; 18 years; at least one implant with erythema, swelling, suppuration, or BOP in the peri-implant mucosa; radiographic bone loss (RBL) &#60; 2 mm.</li>
		<li>Use the following exclusion criteria: peri-implantitis (RBL &#8805; 2 mm); implants with mobility; patients with systematic diseases or under medication that may affect the inflammation and healing process; patients who had received periodontal treatment within 6 months; smokers or alcoholics; pregnant or lactating patients.</li>
	</ol>
	</li>
	<li>Clinical examination
	<ol>
		<li>Measure the clinical parameters PPD, BOP at six sites per implant (i.e., mesiobuccal, buccal, distobuccal, distolingual, lingual, and mesiolingual), and plaque index (PI) at four sites per implant (i.e., mesial, buccal, distal, and lingual).</li>
		<li>Record the baseline parameters on a periodontal chart (Supplementary File 1).</li>
	</ol>
	</li>
	<li>For disinfection, gargle with 3% hydrogen peroxide for 1 min, followed by pure water.</li>
	<li>Mechanical debridement by supragingival scaling
	<ol>
		<li>Use a titanium ultrasound tip to perform supragingival scaling for the mucositis implants, adjusting the mode to medium power (Figure 4B). Rinse the pockets with 3% hydrogen peroxide, and then gargle with pure water. 
		NOTE: Supragingival scaling removes the plaque and calculus from the surface of the implant denture above the gumline.</li>
	</ol>
	</li>
	<li>Professional administration of probiotic
	<ol>
		<li>Grind the probiotic tablet into powder using a sterilized mortar (Figure 4C). 
		NOTE: If there are lumpy particles in the powder, they can easily clog the syringe.</li>
		<li>Make a solution of probiotic powder and sterile saline in a 1:3 ratio (Figure 4D). Deliver the probiotic solution into the peri-implant sulcus using a 5 mL syringe with a blunted and soft tip (Figure 4E).</li>
	</ol>
	</li>
	<li>Home administration of probiotics
	<ol>
		<li>Instruct the patients to dissolve one tablet for approximately 10 min in the oral cavity every 12 h, twice a day for 1 month (Figure 4A).</li>
	</ol>
	</li>
	<li>Give OHI to each patient, including Bass brushing technique, interdental floss, and brush19.</li>
	<li>Clinical examination
	<ol>
		<li>Measure the PPD, PI, and BOP for each implant 4-6 weeks, 3 months, and 6 months after treatment. Record the postoperative parameters on a new periodontal chart (Supplementary File 1).</li>
		<li>Compare the baseline and postoperative parameters.</li>
	</ol>
	</li>
</ol>

The authors have no conflicts of interest.

Although diode laser has been widely utilized in periodontal therapy, the clinical effectiveness remains controversial among current clinical trials15,20. As demonstrated, the laser usage mode and application regimen have significant impacts on the efficacy of periodontal laser therapy12. Most researchers, however, ignore the potential role, eliciting results that are hard to explain. Under different usage modes, excessive or insufficient laser action can lead to negative result21. Only with an optimal combination of usage mode and application regimen can the laser maximize its therapeutic benefits12. There seems to be an urgent need to improve the existing protocol for diode laser therapy. Therefore, in this article, two periodontal laser usage modes (inside pocket or outside pocket) are described in view of the photobiomodulation and photothermal effects. Furthermore, based on published randomized controlled trials, the suggested number of laser appointment sessions under the two usage modes was proposed; for inside pocket use, a single session of laser application is suggested whereas, for outside pocket use, multiple (3-5) sessions of laser application provide a better clinical effect.
It is important to note that laser parameters also affect laser efficacy. Common periodontal laser parameters relate to wavelength, energy density, and output power22. Most studies used diode lasers with 808-980 nm wavelength and reported good clinical results23. The range of 600-1,100 nm diode laser was confirmed to penetrate deep into the tissue, acting on the epithelial and connective tissues of the gingiva20. The energy density ranged from 1.6-24.84 J/cm2 (inside mode) and 3-10 J/cm2 (outside mode). It was reported that lasers with a density of 1.5-16 J/cm2 had good anti-inflammatory properties24. The output power was reported to range between 0.5-2.5 W for the inside application, while it was much lower (0.01-0.5 W) for the outside use. Given that the recommended parameters vary in part among different laser manufacturers, improperly increasing the laser power may cause thermal damage to the periodontal tissues during inside-pocket sweeping25,26. It is strongly recommended to consult the laser manufacturer and determine the appropriate parameters before use. In this protocol, a safe power level of 1 W was chosen for the inside mode.
Considering that probiotic Lactobacillus administration gives reliable results in the management of gingivitis and periodontitis, it is expected to exert similar therapeutic benefits in peri-implant disease. Nevertheless, the limited number of studies makes it difficult to evaluate the effectiveness of probiotic Lactobacillus17,27, especially for the advanced form of the disease, peri-implantitis17,28,29. Thus, the probiotic administration protocol was offered only for patients with peri-implant mucositis. Given the obvious clinical diversity in the published studies, it is crucial to establish a rational protocol with reproducible effect. As a result, we systematically reviewed related studies and suggested a refined protocol, including a combination of professional topical use and home administration of probiotic Lactobacillus and enhancing the OHI.
According to the authors&#39; experience, when choosing the inside pocket mode of laser therapy, it is critical to achieve gentle insertion and continuous movement of the fiber tip. Heavy or deep insertion of the fiber will cause periodontal bleeding, which can weaken the laser effect. Hence, the insertion depth is suggested to be 1 mm shorter than the measured PPD. Prolonged action of a particular site in the pocket can cause excessive photothermal effects (over 10 &#176;C), leading to periodontal pain and even permanent damage to the periodontal ligament and bone30. During this session, the operator should check the fiber tip regularly. Once a blood clot is attached to the tip, it needs to be wiped off with a cotton ball moistened with 75% alcohol to avoid impeding the laser action. Regarding the professional use of probiotic therapy, the concentration of the probiotic solution should not be too high; otherwise, it will easily block the injection needle.
As a modified protocol for existing studies, the probiotic therapy in this paper aims to reduce clinical heterogeneity and contribute to the implementation of future clinical studies in this field. The current result showed that probiotic Lactobacillus therapy led to the disappearance of the peri-implant mucosal swelling, reduced BOP, and obvious reduction and excellent control of plaque and pigmentation after a 1-month follow-up. This demonstrated the effectiveness of probiotics in controlling peri-implant mucosal inflammation. However, PPD improvement was limited. As peri-implant mucositis does not cause bone loss, it only presents as mucosal erythema, swelling, or bleeding, and there is usually no deep peri-implant pocket31. The patient, in this case, had only mild swelling of the mucosa prior to treatment, and therefore, the pre- and post-operative changes in PPD were not significant. Moreover, this protocol should be regarded as preliminary and could be further enhanced (e.g., by using chlorhexidine gargle, increasing the frequency of topical probiotic use, improving the active ingredients of probiotic tablets, etc.)32,33.
Some limitations still exist in the protocol of probiotic therapy. In daily clinical practice, patients&#39; oral hygiene behavior is influenced by various factors. Some have difficulty performing adequate oral hygiene management, despite being professionally instructed. Insufficient home oral cleaning undermines the benefits of professional periodontal treatment and even worsens the condition, especially for probiotic therapy. Thus, it is recommended to reinforce OHI at each follow-up visit and ask patients to practice the procedure again. Besides, the probiotic therapy in this article is not introduced to patients with peri-implantitis, due to its more complex pathology and controversial clinical trial results17. Further studies are required to explore a protocol of probiotic therapy for peri-implantitis.
To facilitate access to the extant studies related to diode laser treatment for periodontitis, and probiotic therapy for peri-implant diseases, a summary of these studies14,28,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47, 
48,49,50,51,52,53,54 is presented in Supplementary File 2 and Supplementary File 3, respectively.

Periodontal disease is a chronic multifactorial infection resulting in progressive destruction of periodontium1. Its severe form, periodontitis, affects up to 50% population worldwide2 and is regarded as a major cause of tooth loss in adults3. Replacement of missing teeth with dental implants has been extensively favored over traditional options4. The implants show prominent functional and aesthetic performances with a long-term survival rate of 96.1% after 10 years5,6. The implants, however, can suffer from peri-implant disease leading to mucosal inflammation (peri-implant mucositis) or surrounding bone loss (peri-implantitis)7, which may cause the implant failure8. Therefore, it is of utmost necessity to manage the periodontal and peri-implant diseases effectively, in order to preserve natural teeth or improve the survival rate of dental implants.
Periodontal and peri-implant diseases share similar etiology9, i.e., both are initiated by exposure to dental plaque, consisting mainly of anaerobic and microaerophilic bacteria10. Mechanical debridement is considered a reliable modality to achieve efficient disruption of pathogenic deposits on root or implant surfaces11. Nevertheless, it has restricted accessibility using instruments when there is complex tooth anatomy (i.e., root furcation and groove), leading to insufficient decontamination12. Under this context, the application of lasers and probiotics has emerged to supplement mechanical debridement13,14.
A variety of lasers have been proposed for periodontal treatment, such as Nd:YAG; CO2; Er:YAG; Er,Cr:YSGG; and diode laser15. Among these, the diode laser is the most popular choice for clinical treatment due to its portability and low cost16. The diode laser has been recommended as an ideal adjunct in destroying biofilms, eliminating inflammation, and facilitating wound healing due to its photobiomodulation and photothermal effects12,13. The diversity of laser usages, nonetheless, leads to significant clinical heterogeneity among current studies. Thus, in our recent publication, we evaluated 30 clinical trials and summarized the optimal combination of laser usage mode and application regimen12. However, few studies report the detailed procedure of the combination protocol. On the other hand, probiotic Lactobacillus has been drawing increasing attention as a potential adjuvant in treating peri-implant disease, due to its antimicrobial and anti-inflammatory performances17,18. The clinical benefits, however, have not reached an agreeable consensus. One critical account referred to the variety of probiotic administration protocols17.
Based on the current evidence, this article describes two modified clinical protocols: the existing protocol for the use of adjunctive diode laser in treating periodontitis is improved based on two laser usage modes (inside or outside pocket) and two application regimens (single or multiple sessions of appointment)12. For the adjunctive probiotic Lactobacillus therapy in treating peri-implant disease, a combination of professional local use and home administration of probiotic is described17.

<table><tbody><tr><td>1% iodophor</td><td>ADF, China</td><td>21031051</td><td>100 mL</td></tr><tr><td>3% hydrogen peroxide</td><td>Hebei Jianning, China</td><td>210910</td><td>500 mL</td></tr><tr><td>75% alcohol</td><td>Shandong Anjie, China</td><td>2021100227</td><td>500 mL</td></tr><tr><td>Diode laser (FOX 980)</td><td>A.R.C, Germany</td><td>PS01013</td><td>300-&amp;mu;m fiber tip</td></tr><tr><td>Gracey curettes</td><td>Hu-Friedy, USA</td><td>5/6, 7/8, 11/12, 13/14</td><td></td></tr><tr><td>Low-speed handpiece</td><td>NSK, Japan</td><td>0BB81855</td><td></td></tr><tr><td>Periodontal probe</td><td>Shanghai Kangqiao Dental Instruments Factory, China</td><td>44759.00</td><td></td></tr><tr><td>Periodontal ultrasonic device (PT3)</td><td>Guilin zhuomuniao Medical Instrument, China</td><td>P2090028PT3</td><td></td></tr><tr><td>Polishing paste</td><td>Datsing, China</td><td>21010701</td><td></td></tr><tr><td>Primacaine adrenaline</td><td>Produits Dentaires Pierre Rolland, France</td><td>S-52</td><td>1.7 mL</td></tr><tr><td>Probiotic</td><td>Biogaia, Sweden</td><td>Prodentis</td><td>30 probiotic tablets (24 g)</td></tr><tr><td>Titanium ultrasound tip (P59)</td><td>Guilin Zhuomuniao Medical Instrument, China</td><td>200805</td><td></td></tr></tbody></table>

adjunctive diode laser therapy and probiotic lactobacillus therapy in the treatment of periodontitis and peri-implant disease

Periodontal and peri-implant diseases are plaque-induced infections with a high prevalence, seriously impairing people&#39;s quality of life. The diode laser has long been recommended as adjunctive therapy in treating periodontitis. However, the optimal combination of usage mode (inside or outside periodontal pocket) and application regimen (single or multiple sessions of appointment) has not been described in detail. Meanwhile, probiotic Lactobacillus is regarded as a potential adjuvant in the management of the peri-implant disease. Nonetheless, a detailed protocol for an effective probiotic application is lacking. This article aims to summarize two clinical protocols. For periodontitis, the optimal collaboration of laser usage mode and application regimen was identified. Regarding peri-implant mucositis, a combined therapy containing professional topical use and home administration of probiotic Lactobacillus was established. This updated laser protocol clarifies the relationship between the treatment mode (inside or outside the periodontal pocket) and the number of laser appointments, further refining the existing diode laser therapy. For inside pocket irradiation, a single session of laser treatment is suggested whereas, for outside pocket irradiation, multiple sessions of laser treatment provide better effects. The improved probiotic Lactobacillus therapy resulted in the disappearance of swelling of the peri-implant mucosa, a reduced bleeding on probing (BOP), and an obvious reduction and good control of plaque and pigmentation; however, probing pocket depth (PPD) had limited improvement. The current protocol should be regarded as preliminary and could be further enhanced.

Periodontal pockets with PPD &#8805; 5 mm require laser irradiation after SRP, as it is difficult to obtain complete debridement by SRP alone (Figure 1A,B). After SRP, if the periodontal pockets bleed profusely and clot on the tooth surface, the operator needs to stop the bleeding and remove the clot by rinsing and gargling several times. This is because a large amount of blood will prevent the laser from working (Figure 1C,D).
The exposed fiber tip is calibrated to be 1 mm less than the measured PPD. Laser parameters were set at 1 W, using continuous wave (Figure 2B). For the recommended laser parameters, one should refer to the manufacturer&#39;s guidelines and adjust the parameters appropriately for different clinical scenarios. The fiber tip was 5 mm away from the gingival surface and directed at an angle of 90&#176; (Figure 3B).
The fully ground probiotic powder has no lumpy particles (Figure 4C). Dissolving it in saline (1:3) results in a green solution (Figure 4D).
Compared to pre-operation (Figure 5A,C), diode laser-assisted SRP therapy (inside or outside mode) effectively removed pathogenic plaque biofilm and eliminated inflammation in patients with periodontitis, achieving significant improvements (i.e., with regards to erythema, swelling, PPD, BOP) (Figure 5B,D). Compared to pre-operation (Figure 5E), probiotic therapy resulted in the disappearance of swelling of the peri-implant mucosa, reduced BOP, and an obvious reduction and good control of plaque and pigmentation; however, there was no significant change in PPD (Figure 5F).
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/63893/63893fig01.jpg" /> 
Figure 1: SRP for periodontitis. (A) A periodontal pocket with PPD = 5 mm. (B) PPD numbers of the tested tooth (mm). SRP is performed for the pocket with PPD &#8805; 4mm, and an adjunctive diode laser treatment is conducted for the pocket with PPD &#8805; 5 mm. (C) SRP with ultrasound instruments. (D) SRP with hand-held instruments. B: buccal; L: lingual; SRP: scaling and root planing. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/63893/63893fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/63893/63893fig02.jpg" /> 
Figure 2: Adjunctive laser therapy inside the periodontal pocket. (A) Phases of the laser treatment with inside mode. (B) Calibration of fiber tip exposed (4 mm) to measure 1 mm less than PPD (5 mm). The fiber tip with a diameter of 300 &#181;m is inserted into the periodontal pocket (1 mm shorter than the measured PPD). (C) The fiber tip is swept in the pocket in mesial-distal and apical-coronal directions (the green curve indicates the path of the fiber tip). <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/63893/63893fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/63893/63893fig03.jpg" /> 
Figure 3: Adjunctive laser therapy outside the periodontal pocket. (A) Phases of the laser treatment with outside mode. (B) The fiber tip irradiates the pocket at a 5 mm distance away from the gingival surface. (C) The distance between the fiber tip and gingival surface ranges from 2-10 mm, and the tip is directed at an angle of 90&#176;. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/63893/63893fig03large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/63893/63893fig04.jpg" /> 
Figure 4: Supragingival scaling and adjunctive probiotic Lactobacillus therapy. (A) Phases of the probiotic Lactobacillus therapy. (B) A titanium ultrasound tip is used to perform supragingival scaling for mucositis implants. (C) The probiotic powder. (D) The probiotic solution with a green color. (E) The probiotic solution is delivered into the peri-implant sulcus with a blunted and soft tip. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/63893/63893fig04large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/63893/63893fig05.jpg" /> 
Figure 5: Clinical examination before and 1 month after treatment. (A) One month after laser treatment in the inside usage mode, gingival erythema and swelling disappeared, and PPD and BOP were greatly reduced compared to the (B) pre-operation condition. (C) One month after laser treatment in the outside usage mode, gingival erythema and swelling improved, and PPD and BOP reduced as compared with the (D) pre-operation condition. (E) After 1 month of probiotic therapy, peri-implant mucosal swelling disappeared, pigmentation and plaque were reduced and well-controlled, and BOP was reduced as compared with the (F) pre-operation condition; however, there was no significant change in PPD relative to the pre-operation condition (F). <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/63893/63893fig05large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
Supplementary File 1: Periodontal chart. B: buccal; BOP: bleeding on probing; CAL: clinical attachment loss; L: lingual; PI: plaque index; PPD: probing pocket depth. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/63893/Supplementary File 1.zip" target="_blank">Please click here to download this File.</a>
Supplementary File 2: Characteristics of studies referring to adjunctive laser therapy. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/63893/Supplementary File 2.zip" target="_blank">Please click here to download this File.</a>
Supplementary File 3: Characteristics of studies referring to adjunctive probiotic Lactobacillus therapy. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/63893/Supplementary File 3.zip" target="_blank">Please click here to download this File.</a>

Watch this Scientific Journal Video about Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease at JoVE.com

Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease

This article describes two protocols: 1) adjunctive diode laser therapy for treating periodontitis and 2) probiotic Lactobacillus therapy for treating peri-implant disease, with emphasis on the laser usage mode (inside or outside pocket), laser application regimen (single or multiple sessions), and a probiotic protocol of professional and home administration.

Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease

Periodontal and peri-implant diseases are plaque-induced infections with a high prevalence, seriously impairing people&#39;s quality of life. The diode ...

adjunctive-diode-laser-therapy-probiotic-lactobacillus-therapy

Nanyang Technological University

Research

JoVE Journal

Medicine

2.4K Views.  Xi’an Jiaotong University. Parodontitis en de peri-implantaatziekte zijn plaque-geïnduceerde laesies die de kwaliteit van leven van de mensen ernstig beïnvloeden. Ons protocol kan betrouwbaardere uitkomsten bieden voor deze patiënten omdat het is verbeterd dan de bestaande maatregelen. Dit protocol biedt een optimale combinatie van lasergebruiksmodus en toepassingsregime voor parodontitis.Ondertussen introduceert het een combinatie van professioneel en thuisgebruik van probiotica voor peri-implantaat mucositi...

Video: Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease

The Synergistic Effect of Visible Light and Gentamycin on Pseudomona aeruginosa Microorganisms

Recently there were several publications on the bactericidal effect of visible light, most of them claiming that blue part of the spectrum (400 nm-500 nm) is responsible for killing various pathogens1-5. The phototoxic effect of blue light was suggested to be a result of light-induced reactive oxygen species (ROS) formation by endogenous bacterial photosensitizers which mostly absorb light in the blue region4,6,7. There are also reports of biocidal effect of red and near infra red8 as well as green light9.
In the present study, we developed a method that allowed us to characterize the effect of high power green (wavelength of 532 nm) continuous (CW) and pulsed Q-switched (Q-S) light on Pseudomonas aeruginosa. Using this method we also studied the effect of green light combined with antibiotic treatment (gentamycin) on the bacteria viability. P. aeruginosa is a common noscomial opportunistic pathogen causing various diseases. The strain is fairly resistant to various antibiotics and contains many predicted AcrB/Mex-type RND multidrug efflux systems10.
The method utilized free-living stationary phase Gram-negative bacteria (P. aeruginosa strain PAO1), grown in Luria Broth (LB) medium exposed to Q-switched and/or CW lasers with and without the addition of the antibiotic gentamycin. Cell viability was determined at different time points. The obtained results showed that laser treatment alone did not reduce cell viability compared to untreated control and that gentamycin treatment alone only resulted in a 0.5 log reduction in the viable count for P. aeruginosa. The combined laser and gentamycin treatment, however, resulted in a synergistic effect and the viability of P. aeruginosa was reduced by 8 log's.
The proposed method can further be implemented via the development of catheter like device capable of injecting an antibiotic solution into the infected organ while simultaneously illuminating the area with light.

The Synergistic Effect of Visible Light and Gentamycin on Pseudomona aeruginosa Microorganisms

We show that a developed biomedical device involving continuous or pulsed visible laser based treatment that is combined with antibiotic treatment (gentamycin), results in a statistically significant synergistic effect leading to a reduction in the viability of P. aeruginosa PAO1, by 8 log's compared to antibiotic treatment alone.

Recently there were several publications on the  bactericidal effect of visible light, most of them claiming that blue part of  the spectrum (400 nm-500 ...

Immunology and Infection

Anti-virulent Disruption of Pathogenic Biofilms using Engineered Quorum-quenching Lactonases

The rapid emergence of multi-drug resistant bacteria has accelerated the need for novel therapeutic approaches to counter life-threatening infections. The persistence of bacterial infection is often associated with quorum-sensing-mediated biofilm formation. Thus, the disruption of this signaling circuit presents an attractive anti-virulence strategy. Quorum-quenching lactonases have been reported to be effective disrupters of quorum-sensing circuits. However, there have been very few reports of the effective use of these enzymes in disrupting bacterial biofilm formation. This protocol describes a method to disrupt biofilm formation in a clinically relevant A. baumannii S1 strain through the use of an engineered quorum-quenching lactonase. Acinetobacter baumannii is a major human pathogen implicated in serious hospital-acquired infections globally and its virulence is attributed predominantly to its biofilm's tenacity. The engineered lactonase treatment achieved significant A. baumannii S1 biofilm reduction. This study also showed the possibility of using engineered quorum-quenching enzymes in future treatment of biofilm-mediated bacterial diseases. Lastly, the method may be used to evaluate the competency of promising quorum-quenching enzymes.

Quorum-quenching enzymes are anti-virulent and anti-bacterial options that can mitigate pathogenesis without risk of incurring resistance, by preventing the expression of virulence factors and genes associated with antibiotic resistance and biofilm formation. In this study, we report a method that demonstrates the efficacy of quorum-quenching enzymes in bacterial biofilm disruption.

The rapid emergence of multi-drug resistant bacteria has accelerated the need for novel therapeutic approaches to counter life-threatening infections. The ...

Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain

Chronic or neuropathic trigeminal facial pain can be challenging to treat. Neurosurgical procedures should be applied when conservative treatment fails. Neuromodulation techniques for chronic facial pain include deep brain stimulation and motor cortex stimulation, which are complex to perform. Subcutaneous nerve field stimulation is certified for chronic back pain and is the least invasive form of neuromodulation. We applied this technique to treat chronic and neuropathic trigeminal pain as an individual therapy concept. First, trial stimulation is performed. Subcutaneous leads are placed in the painful trigeminal dermatome under local anesthesia. The leads are connected to an external neurostimulator that applies constant stimulation. Patients undergo a 12 day outpatient trial to assess the effect of the stimulation. Electrodes are removed after the trial. If the patient reports pain reduction of at least 50% in intensity and/or attack frequency, a reduction in medication or increase in quality of life, permanent implantation is scheduled. New electrodes are implanted under general anesthesia and are subcutaneously tunneled to an infraclavicular internal pulse generator. Patients are able to turn stimulation on and off and to increase or decrease the stimulation amplitude as needed.
This technique represents a minimal invasive alternative to other more invasive means of neuromodulation for trigeminal pain such as motor cortex stimulation or deep brain stimulation.

Treating chronic or neuropathic facial pain can be challenging when medical or standard treatment fails. Subcutaneous nerve field stimulation is the least invasive form of neuromodulation and is used for chronic back pain. We applied this technology to treat chronic and neuropathic trigeminal facial pain.

Chronic or neuropathic trigeminal facial pain can be challenging to treat. Neurosurgical procedures should be applied when conservative treatment fails. ...

Daily Phototherapy with Red Light to Regulate Candida albicans Biofilm Growth

Here, we present a protocol to assess the outcomes of per diem red light treatment on the growth of Candida albicans biofilm. To increase the planktonic growth of C. albicans SN425, the inoculums grew on Yeast Nitrogen Base media. For biofilm formation, RPMI 1640 media, which have high concentrations of amino acids, were applied to help biofilm growth. Biofilms of 48 h were treated twice a day for a period of 1 min with a non-coherent light device (red light; wavelength = 635 nm; energy density = 87.6 J&#183;cm-2). As a positive control (PC), 0.12% chlorhexidine (CHX) was applied, and as a negative control (NC), 0.89% NaCl was applied to the biofilms. Colony forming units (CFU), dry-weight, soluble and insoluble exopolysaccharides were quantified after treatments. Briefly, the protocol presented here is simple, reproducible and provides answers regarding viability, dry-weight and extracellular polysaccharide amounts after red light treatment.

Daily Phototherapy with Red Light to Regulate Candida albicans Biofilm Growth

Here, we present a protocol to assess the outcome of red light application on the growth of Candida albicans biofilm. A non-coherent red light device with the wavelength of 635 nm and energy density of 87.6 J&#183;cm-2 was applied throughout the growth of Candida albicans biofilms for 48 h.

Here, we present a protocol to assess the outcomes of per diem red light treatment on the growth of Candida albicans biofilm. To increase the planktonic ...

Transcanalicular Diode Laser-assisted Dacryocystorhinostomy for the Treatment of Primary Acquired Nasolacrimal Duct Obstruction

Today&#39;s gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), a relatively invasive procedure that can be performed after failure of recanalizing treatments. However, with progress in the field of diode laser technology, new approaches have emerged. Laser-assisted transcanalicular DCR with subsequent bicanalicular silicon intubation is a new option showing great promise as a viable minimally invasive procedure. Under permanent endoscopic visual control from the nasal cavity, a diode laser fiber is inserted into the lacrimal sac and laser energy is applied to create a bony ostium between the lacrimal sac and the nasal cavity. Since no skin incision needs to be made, advantages of this method comprise the sparing of the skin as well as the medial palpebral structures and the physiological palpebral-canalicular pump mechanism. The duration of surgery as well as reconvalescence is generally shorter than with external DCR. Complications include silicon tube prolapse, mild swelling and, rarely, canalicular infection and thermal injury. One-year functional success rates, defined as complete resolution of symptoms and ostium patency, are high, yet still range behind those of external DCR. However, secondary external DCR after failure of laser-assisted DCR can be performed without difficulty. Thus, laser-assisted transcanalicular DCR is a valid option that should be considered as a second-step procedure after failure of recanalization procedures and before external DCR.

The goal of this protocol is to present transcanalicular laser-assisted dacryocystorhinostomy as a minimally invasive approach in the treatment of primary acquired nasolacrimal duct obstruction.

Today&#39;s gold standard in the treatment of infrasaccal primary acquired nasolacrimal duct obstruction (PANDO) is external dacryocystorhinostomy (DCR), ...

Rose Bengal-Mediated Photodynamic Therapy to Inhibit Candida albicans

Invasive Candida albicans infection is a significant opportunistic fungal infection in humans because it is one of the most common colonizers of the gut, mouth, vagina, and skin. Despite the availability of antifungal medication, the mortality rate of invasive candidiasis remains ~50%. Unfortunately, the incidence of drug-resistant C. albicans is increasing globally. Antimicrobial photodynamic therapy (aPDT) may offer an alternative or adjuvant treatment to inhibit C. albicans biofilm formation and overcome drug resistance. Rose bengal (RB)-mediated aPDT has shown effective cell killing of bacteria and C. albicans. In this study, the efficacy of RB-aPDT on multidrug-resistant C. albicans is described. A homemade green light-emitting diode (LED) light source is designed to align with the center of a well of a 96-well plate. The yeasts were incubated in the wells with different concentrations of RB and illuminated with varying fluences of green light. The killing effects were analyzed by the plate dilution method. With an optimal combination of light and RB, 3-log growth inhibition was achieved. It was concluded that RB-aPDT might potentially inhibit drug-resistant C. albicans.

Rose Bengal-Mediated Photodynamic Therapy to Inhibit Candida albicans

The growing incidence of drug-resistant Candida albicans is a serious health issue worldwide. Antimicrobial photodynamic therapy (aPDT) may offer a strategy to fight against drug-resistant fungal infections. The present protocol describes Rose bengal-mediated aPDT efficacy on a multidrug-resistant C. albicans strain in vitro.

Invasive Candida albicans infection is a significant opportunistic fungal infection in humans because it is one of the most common colonizers of the gut, ...

Induction of Periodontitis via a Combination of Ligature and Lipopolysaccharide Injection in a Rat Model

Periodontitis (PD) is a highly prevalent, chronic immune-inflammatory disease of the periodontium, that results in a loss of gingival soft tissue, periodontal ligament, cementum, and alveolar bone. In this study, a simple method of PD induction in rats is described. We provide detailed instructions for placement of the ligature model around the first maxillary molars (M1) and a combination of injections of lipopolysaccharide (LPS), derived from Porphyromonas gingivalis at the mesio-palatal side of the M1. The induction of periodontitis was maintained for 14 days, promoting the accumulation of bacteria biofilm and inflammation. To validate the animal model, IL-1&#946;, a key inflammatory mediator, was determined by an immunoassay in the gingival crevicular fluid (GCF), and alveolar bone loss was calculated using cone beam computed tomography (CBCT). This technique was effective in promoting gingiva recession, alveolar bone loss, and an increase in IL-1&#946; levels in the GCF at the end of the experimental procedure after 14 days. This method was effective in inducing PD, thus being able to be used in studies on disease progression mechanisms and future possible treatments.

Induction of Periodontitis via a Combination of Ligature and Lipopolysaccharide Injection in a Rat Model

In this study, a rat model of induction of periodontitis is presented via a combination of retentive ligature and repetitive injections of lipopolysaccharide derived from Porphyromonas gingivalis, over 14 days around the first maxillary molars. The ligation and LPS injection techniques were effective in inducing peridontitis, resulting in alveolar bone loss and inflammation.

Periodontitis (PD) is a highly prevalent, chronic immune-inflammatory disease of the periodontium, that results in a loss of gingival soft tissue, ...

Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia Using a 980 nm Diode Laser

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. Here, we introduce a new technique called 980 nm diode laser enucleation (DiLEP) to treat BPH1. Diode lasers can absorb both water and hemoglobin at the same time, so they are good for cutting and hemostasis2. The diode laser was approved by the FDA in 2007, and has been used in the treatment of BPH because of its effective cutting and hemostasis effect3. DiLEP presents several advantages over other techniques, such as TURP, HoLEP, and PVP. During the procedure, we define the boundary of a high-volume prostate and separate it into three lobes with a diode laser by burning two rings and one groove (like a Cupid&#39;s arrow). Compared to other procedures, mDiLEP has fewer intraoperative complications, a shorter learning curve, and achieves more tissue resection.

Here, we present a protocol for modified 980 nm diode laser enucleation to treat large volume benign prostatic hyperplasia.

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. ...

Experimental Model of Ligature-Induced Peri-Implantitis in Mice

Dental implants have a high success and survival rate. However, complications such as peri-implantitis (PI) are highly challenging to treat. PI is characterized by inflammation in the tissues around dental implants with progressive loss of supporting bone. To optimize dental implants' longevity in terms of health and functionality, it is crucial to understand the peri-implantitis pathophysiology. In this regard, using mouse models in research has proven clear benefits in recreating clinical circumstances. This study aimed to describe an experimental model of ligature-induced peri-implantitis in mice and determine whether there is effectiveness in inducing this disease, given the observed bone and tissue changes. The experimental peri-implantitis induction comprehends the following steps: teeth extraction, implant placement, and ligature-inducted PI. A sample of eighteen 3-week-old C57BL/6J male mice was divided into two groups, ligature (N=9) and control non-ligature (N=9). The evaluation of clinical, radiographical, and histological factors was performed. The ligature group showed significantly higher bone loss, increased soft tissue edema, and apical epithelial migration than the non-ligature group. It was concluded that this pre-clinical model can successfully induce peri-implantitis in mice.

This is a report on an experimental model of ligature-induced peri-implantitis in mice. We describe all surgical steps, from pre- and post-operative management of the animals, extractions, implant placement, and ligature-induced peri-implantitis.

Dental implants have a high success and survival rate. However, complications such as peri-implantitis (PI) are highly challenging to treat. PI is ...

Minimizing Pigmentation in Laser Treatment Using Salicylic Acid

Enhancement of Facial Rejuvenation Through a Combination of 1565 nm Non-Ablative Fractional Laser with 30% Supramolecular Salicylic Acid

The 1565 nm non-ablative fractional laser can effectively stimulate collagen regeneration, achieving the effect of skin rejuvenation and anti-aging. In recent years, it has been widely used in dermatology, especially in facial rejuvenation, treatment of stretch marks, and acne scar treatment, with significant results. However, after the 1565 nm non-ablative fractional laser treatment, patients may experience short-term erythema and edema. The inflammation after treatment may also cause pigmentation, making it difficult for some patients to accept. This article introduces a treatment method of 1565 nm non-ablative fractional laser combined with 30% super molecular salicylic acid for facial rejuvenation, effectively reducing posttreatment erythema and post-inflammatory pigmentation. The method includes specific treatment steps and the respective endpoint reactions of each step. The method starts by selecting appropriate energy parameters for the 1565 nm non-ablative fractional laser treatment, followed immediately by the application of 30% supramolecular salicylic acid. The treatment should be stopped when a frosty reaction occurs. The purpose of this project is to provide patients with a safer new method of facial rejuvenation treatment.

Author Spotlight: Advancing Facial Rejuvenation Therapy with Post-Laser Salicylic Acid Application

The purpose of this project is to effectively reduce the occurrence of adverse reactions such as erythema and pigmentation after non-ablative fractional laser treatment by combining 1565 non-ablative fractional laser with 30% super molecular salicylic acid, providing patients with a safer new method of facial rejuvenation treatment.

The 1565 nm non-ablative fractional laser can effectively stimulate collagen regeneration, achieving the effect of skin rejuvenation and anti-aging. In ...

Adjunctive Diode Laser Therapy and Probiotic Lactobacillus Therapy in the Treatment of Periodontitis and Peri-Implant Disease

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