Study of Scaling and Root Planing (SRP) With PerioWave vs. SRP Alone in Chronic Periodontitis

Periodontitis Clinical Trial

Official title:

A Multicenter, Randomized, Examiner Blinded Study of Photoactivated Disinfection With Scaling and Root Planing in the Treatment of Chronic Periodontitis

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00297518
• Other study ID #: ORL-0605-5
• Status: Completed
• Phase: Phase 4
• First received: February 24, 2006
• Last updated: May 17, 2007
• Start date: March 2006
• Est. completion date: January 2007

Study information

• Verified date: May 2007
• Source: Ondine Research Laboratories
• Contact: n/a
• Is FDA regulated: No
• Health authority: Canada: Ethics Review Committee
• Study type: Interventional

Clinical Trial Summary

This study is to determine whether scaling and root planning (SRP) followed by photodynamic disinfection results in improved outcomes that persist over time in adults with chronic periodontitis when compared with subjects with SRP alone.

Description:

Extensive research has shown that lethal photosensitization with low levels of laser light is an effective method of killing numerous types of organisms. This therapy avoids the use of antibiotics along with their potential side effects. The initial application of this therapy to the oral cavity is particularly appropriate since the therapy can be applied topically either in a specific or general fashion, killing is immediate and resistance is unlikely as it is free radical-mediated. In addition, the disease states being treated (gingivitis & periodontitis) are highly prevalent and associated with significant morbidity. The equipment and costs of this therapy are simple, easily applied and relatively inexpensive compared with current therapies. Based on the scientific data to date this therapy has the potential of significantly improving the oral health of those affected.

This is a pivotal, prospective, randomized, examiner blinded, multicenter study to evaluate the effect of a single treatment of photodynamic disinfection in adults with chronic periodontal disease.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 40
• Est. completion date: January 2007
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. The subject is capable of giving informed consent

2. The subject is willing to sign a consent form

3. The subject is an adult male or female > 18

4. The subject is diagnosed with chronic periodontitis

5. The subject has >18 fully erupted teeth

6. The subject has at least 4 measurement sites with pocket depth of 6-9 mm in at least two quadrants of the mouth.

7. Subject is willing and able to return for treatment and evaluation procedures scheduled throughout the course of this clinical study

Exclusion Criteria:

1. The subject is pregnant or nursing or who plans to become pregnant in the next 4 months

2. The subject has significant liver disease by subject report

3. The subject has an active malignancy of any type by subject report

4. The subject has chronic disease or diminished mental capacity that would mitigate the ability to comply with the protocol

5. The subject has any significant disease (either acute or chronic) or who is taking a medication with concomitant oral manifestations that in the opinion of the investigator would interfere with evaluation of safety or efficacy of PERIOWAVE®

6. The subject has an active periapical abscess or periodontal abscess or a history of acute necrotizing ulcerative gingivitis

7. The subject has been treated with antibiotics within the 1-month period prior to beginning the study or any systemic condition which requires antibiotic coverage for routine periodontal procedures (e.g. heart conditions, joint replacements, etc.) by report of the subject

8. The subject has a known allergy to Methylene Blue

9. Has glucose-6-phosphate dehydrogenase (G6PD) deficiency by subject report

10. The subject currently uses anti-coagulant therapy at therapeutic doses

11. The subject is currently using any photosensitizing medications

12. The subject has participated in investigational treatment in the last 30 days or has the expectation for using a separate investigational treatment during the time of the study

13. The subject has smoked tobacco products in the last year

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Chronic Periodontitis
• Periodontitis

Intervention

Device:
• PerioWave

Procedure:
• Scaling and Root Planing

Locations

Country	Name	City	State
Canada	Office of Dr. Sonia Leziy	North Vancouver	British Columbia
Canada	University of British Columbia School of Dentistry	Vancouver	British Columbia

Sponsors (1)

Lead Sponsor	Collaborator
Ondine Research Laboratories

Country where clinical trial is conducted

Canada, 

References & Publications (43)

Albandar JM, Brunelle JA, Kingman A. Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-1994. J Periodontol. 1999 Jan;70(1):13-29. Erratum in: J Periodontol 1999 Mar;70(3):351. — View Citation

Albandar JM, Kingman A. Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994. J Periodontol. 1999 Jan;70(1):30-43. — View Citation

Antczak-Bouckoms A, Joshipura K, Burdick E, Tulloch JF. Meta-analysis of surgical versus non-surgical methods of treatment for periodontal disease. J Clin Periodontol. 1993 Apr;20(4):259-68. — View Citation

Bertoloni G, Zambotto F, Conventi L, Reddi E, Jori G. Role of specific cellular targets in the hematoporphyrin-sensitized photoinactivation of microbial cells. Photochem Photobiol. 1987 Nov;46(5):695-8. — View Citation

Bhatti M, MacRobert A, Meghji S, Henderson B, Wilson M. A study of the uptake of toluidine blue O by Porphyromonas gingivalis and the mechanism of lethal photosensitization. Photochem Photobiol. 1998 Sep;68(3):370-6. — View Citation

Bhatti M, Nair SP, Macrobert AJ, Henderson B, Shepherd P, Cridland J, Wilson M. Identification of photolabile outer membrane proteins of Porphyromonas gingivalis. Curr Microbiol. 2001 Aug;43(2):96-9. — View Citation

Birch JF, Mandley DJ, Williams SL, Worrall DR, Trotter PJ, Wilkinson F, Bell PR. Methylene blue based protein solder for vascular anastomoses: an in vitro burst pressure study. Lasers Surg Med. 2000;26(3):323-9. — View Citation

Brown LJ, Johns BA, Wall TP. The economics of periodontal diseases. Periodontol 2000. 2002;29:223-34. Review. — View Citation

Chung WO, Gabany J, Persson GR, Roberts MC. Distribution of erm(F) and tet(Q) genes in 4 oral bacterial species and genotypic variation between resistant and susceptible isolates. J Clin Periodontol. 2002 Feb;29(2):152-8. — View Citation

Consensus report. Periodontal diseases: epidemiology and diagnosis. Ann Periodontol. 1996 Nov;1(1):216-22. Review. — View Citation

De Soete M, Mongardini C, Peuwels M, Haffajee A, Socransky S, van Steenberghe D, Quirynen M. One-stage full-mouth disinfection. Long-term microbiological results analyzed by checkerboard DNA-DNA hybridization. J Periodontol. 2001 Mar;72(3):374-82. — View Citation

Dobson J, Wilson M. Sensitization of oral bacteria in biofilms to killing by light from a low-power laser. Arch Oral Biol. 1992 Nov;37(11):883-7. — View Citation

Dougherty TJ, Grindey GB, Fiel R, Weishaupt KR, Boyle DG. Photoradiation therapy. II. Cure of animal tumors with hematoporphyrin and light. J Natl Cancer Inst. 1975 Jul;55(1):115-21. — View Citation

Frentzen M, Koort HJ. Lasers in dentistry: new possibilities with advancing laser technology? Int Dent J. 1990 Dec;40(6):323-32. Review. — View Citation

Goodson JM. Antimicrobial strategies for treatment of periodontal diseases. Periodontol 2000. 1994 Jun;5:142-68. Review. — View Citation

Haffajee AD, Cugini MA, Dibart S, Smith C, Kent RL Jr, Socransky SS. Clinical and microbiological features of subjects with adult periodontitis who responded poorly to scaling and root planing. J Clin Periodontol. 1997 Oct;24(10):767-76. — View Citation

Haffajee AD, Socransky SS. Microbial etiological agents of destructive periodontal diseases. Periodontol 2000. 1994 Jun;5:78-111. Review. — View Citation

Herrera D, Sanz M, Jepsen S, Needleman I, Roldán S. A systematic review on the effect of systemic antimicrobials as an adjunct to scaling and root planing in periodontitis patients. J Clin Periodontol. 2002;29 Suppl 3:136-59; discussion 160-2. Review. — View Citation

Hujoel PP, Powell LV, Kiyak HA. The effects of simple interventions on tooth mortality: findings in one trial and implications for future studies. J Dent Res. 1997 Apr;76(4):867-74. — View Citation

Hung HC, Douglass CW. Meta-analysis of the effect of scaling and root planing, surgical treatment and antibiotic therapies on periodontal probing depth and attachment loss. J Clin Periodontol. 2002 Nov;29(11):975-86. — View Citation

Johnson V, Johnson BD, Sims TJ, Whitney CW, Moncla BJ, Engel LD, Page RC. Effects of treatment on antibody titer to Porphyromonas gingivalis in gingival crevicular fluid of patients with rapidly progressive periodontitis. J Periodontol. 1993 Jun;64(6):559-65. — View Citation

Kalkwarf KL, Kaldahl WB, Patil KD. Patient preference regarding 4 types of periodontal therapy following 3 years of maintenance follow-up. J Clin Periodontol. 1992 Nov;19(10):788-93. — View Citation

Lindhe J, Nyman S. Long-term maintenance of patients treated for advanced periodontal disease. J Clin Periodontol. 1984 Sep;11(8):504-14. — View Citation

Luksiene Z. Photodynamic therapy: mechanism of action and ways to improve the efficiency of treatment. Medicina (Kaunas). 2003;39(12):1137-50. Review. — View Citation

Malik Z, Hanania J, Nitzan Y. Bactericidal effects of photoactivated porphyrins--an alternative approach to antimicrobial drugs. J Photochem Photobiol B. 1990 May;5(3-4):281-93. Review. — View Citation

Martinetto P, Gariglio M, Lombard GF, Fiscella B, Boggio F. Bactericidal effects induced by laser irradiation and haematoporphyrin against gram-positive and gram-negative microorganisms. Drugs Exp Clin Res. 1986;12(4):335-42. — View Citation

McFall WT Jr. Tooth loss in 100 treated patients with periodontal disease. A long-term study. J Periodontol. 1982 Sep;53(9):539-49. — View Citation

Niederman R, Abdelshehid G, Goodson JM. Periodontal therapy using local delivery of antimicrobial agents. Dent Clin North Am. 2002 Oct;46(4):665-77, viii. — View Citation

O'Neill J, Wilson M, Wainwright M. Comparative antistreptococcal activity of photobactericidal agents. J Chemother. 2003 Aug;15(4):329-34. — View Citation

Oral health in America: a report of the Surgeon General. J Calif Dent Assoc. 2000 Sep;28(9):685-95. — View Citation

Paardekooper M, De Bruijne AW, Van Steveninck J, Van den Broek PJ. Inhibition of transport systems in yeast by photodynamic treatment with toluidine blue. Biochim Biophys Acta. 1993 Sep 19;1151(2):143-8. — View Citation

Paardekooper M, De Bruijne AW, Van Steveninck J, Van den Broek PJ. Intracellular damage in yeast cells caused by photodynamic treatment with toluidine blue. Photochem Photobiol. 1995 Jan;61(1):84-9. — View Citation

Paardekooper M, Van den Broek PJ, De Bruijne AW, Elferink JG, Dubbelman TM, Van Steveninck J. Photodynamic treatment of yeast cells with the dye toluidine blue: all-or-none loss of plasma membrane barrier properties. Biochim Biophys Acta. 1992 Jul 8;1108(1):86-90. — View Citation

Position paper: epidemiology of periodontal diseases. American Academy of Periodontology. J Periodontol. 1996 Sep;67(9):935-45. Review. — View Citation

Quirynen M, Op Heij DG, Adriansens A, Opdebeeck HM, van Steenberghe D. Periodontal health of orthodontically extruded impacted teeth. A split-mouth, long-term clinical evaluation. J Periodontol. 2000 Nov;71(11):1708-14. — View Citation

Renvert S, Wikström M, Dahlén G, Slots J, Egelberg J. Effect of root debridement on the elimination of Actinobacillus actinomycetemcomitans and Bacteroides gingivalis from periodontal pockets. J Clin Periodontol. 1990 Jul;17(6):345-50. — View Citation

Sbordone L, Ramaglia L, Gulletta E, Iacono V. Recolonization of the subgingival microflora after scaling and root planing in human periodontitis. J Periodontol. 1990 Sep;61(9):579-84. — View Citation

Smetana Z, Ben-Hur E, Mendelson E, Salzberg S, Wagner P, Malik Z. Herpes simplex virus proteins are damaged following photodynamic inactivation with phthalocyanines. J Photochem Photobiol B. 1998 Jun 15;44(1):77-83. — View Citation

Socransky SS, Haffajee AD. Evidence of bacterial etiology: a historical perspective. Periodontol 2000. 1994 Jun;5:7-25. Review. — View Citation

Wainwright M. Photodynamic antimicrobial chemotherapy (PACT). J Antimicrob Chemother. 1998 Jul;42(1):13-28. Review. — View Citation

Wilson M, Dobson J, Harvey W. Sensitization of oral bacteria to killing by low-power laser radiation. Curr Microbiol. 1992 Aug;25(2):77-81. — View Citation

Wilson M, Dobson J, Sarkar S. Sensitization of periodontopathogenic bacteria to killing by light from a low-power laser. Oral Microbiol Immunol. 1993 Jun;8(3):182-7. — View Citation

Wilson M, Mia N. Sensitisation of Candida albicans to killing by low-power laser light. J Oral Pathol Med. 1993 Sep;22(8):354-7. — View Citation

* Note: There are 43 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Increase in Clinical Attachment Level		6, 12 weeks
Secondary	Reduction in Periodontal Pocket Depth		6, 12 weeks
Secondary	Reduction in Bleeding on Probing		6, 12 weeks