歯周炎の非外科的治療における光線力学的療法（PDT）

Photodynamic therapy (PDT) in non-surgical treatment of periodontitis.

抄録

歯周炎は，薬物療法では原因菌を除去できないため，患者にとって大きな問題である。本研究では，波長635nmのレーザー光源と光活性物質（メチレンブルー）を用いた光線力学療法（PDT）による殺菌を行った歯周炎患者44名を対象とした．臨床評価は、プラーク指数（PI）、プロービング出血（BOP）、プロービングデプス（PD）、カルシュラス指数（CI）、歯肉退縮（REC）、臨床付着レベル（CAL）をベースライン時、治療後1ヶ月（4週間）、治療後3ヶ月（12週間）に記録し、部位X線撮影（RX）と微生物試験（MT）はベースライン時と3ヶ月（12週間）後に記録された。その結果、PDTは歯周病原性細菌叢の除去と臨床パラメータの改善において良好な効果を示した。85％、BOPが約93.3％、PDが約17％、CIが約66.3％、PIが約44％、微生物学的には歯周病特性が証明された細菌（赤色複合細菌）の総量が約58.74％減少していることが観察された。本研究の範囲内では，PDTは，考慮したパラメーター（臨床的および微生物学的）の有意な改善をもたらす優れたキャリアであると合理的に考えることができる．

Periodontitis represents a major problem for patients, since it is not possible to eliminate the bacteria that are responsible for this pathology with a pharmacological treatment. The present study included forty-four patients with periodontitis, who had undergone disinfection via photodynamic therapy (PDT) using a laser source having a 635 nm wavelength associated with a photoactivable substance (methylene blue). Clinical assessment of plaque index (PI), bleeding on probing (BOP), probing depth (PD), calculus index (CI), gingival recession (REC) and clinical attachment level (CAL) were recorded at base line, 1 month (4 weeks) after treatment and again 3 months (12 weeks) after treatment, while site radiography (RX) and microbiological test (MT) were recorded at base line and 3 months (12 weeks) after treatment. The outcomes show a good efficacy of the PDT in the elimination of the periodontal pathogenic microflora and in the improvement of the clinical parameters considered: from the base line to the final check after 12 weeks it has been observed a reduction in REC of about 16.9%, a reduction of CAL of about 17.85%, a reduction of the BoP of about 93.3%, a reduction of the PD of about 17%, a reduction of the CI of about 66.3%, a reduction of PI of about 44%, and microbiologically a reduction of the total amount of bacteria with proven parodontopathic properties (red complex bacteria) of about 58.74%. Within the limits of the present study, PDT can be reasonably considered as a good carrier that leads to significant improvements in the parameters (clinical and microbiological) considered.