The effect of Chitosan as a photoactivatable bioactive nanoparticle on nonsurgical management stage one and two of periodontitis

Abstract

The properties of chitosan as an antimicrobial substance with a relatively favorable immune response results in its common usage in the treatment of diseases such as chronic periodontitis. As a photoactivatable bioactive nanoparticle, chitosan is also effectively used in photodynamic therapy. The aim of this clinical study was to evaluate the effect of Chitosan as a photoactivatable bioactive nanoparticle on non-surgical treatment of first and second stage periodontitis. Methods and materials: The present study was performed as a double-blind clinical trial on 31 patients at the Faculty of Dentistry of Tabriz University of Medical Sciences. Patients were randomly assigned to the control group who received Mechanichal Debridement alone (MD) or the test group (MD + Chitosan). Patients' consent was obtained before participating in the study. At the beginning of the study, a primary plaque index was prepared sampling all areas of the mouth. The same parameters were measured in two-week and three-month intervals respectively. Oral Hygiene Instruction, removal of plaque retaining factors, and mechanical full mouth debridement (MD) using piezoelectric scaler, followed by hand instruments were performed For all patients. In the chitosan group, first, the solution containing the nanoparticles was injected into the pocket from the most apical point of the pocket to the coronal with an insulin syringe with a blunt head and then a 5% solution of chitosan (prepared by the researcher) was injected with another insulin syringe. Then the area was irradiated with a green laser with a wavelength of 532 nm for 60 seconds. Patients in the control group, had insulin syringes been inserted into the pocket but received no injection. The laser was also placed in the area with no radiation applied. Clinical parameters of BOP, PD, CAL and GR were measured as baseline data, respectively two weeks and three months later. An adapted acrylic stent was made prior to any clinical measurements to enable doing all measurements through prepared grooves on the stent. This measurement was performed by a calibrated assessor clinician using a single type of Periodontal probe. Calibrated assessor clinician was unaware of the type of treatment performed during the treatment process. For microbiological examination, the patient's periodontal pocket was sampled.Drying the sampling area and isolating it with a cotton roll, the gingival crevicular fluid sample was taken from the periodontal pocket of the patient with chronic periodontitis with paper cone for 30 seconds. The paper cone then entered to carrier medium (thioglycolic acid) and transferred to the laboratory within an hour. Müller-Hinton Bruce culture medium with 10 μg / ml of vitamin K was used for the initial growth of the samples. Then 100 μL of microbial sample was added to each of the above media (except negative control group). Four samples, the area was irradiated with green laser with a wavelength of 532 nm for 60 seconds, then under anaerobic conditions in the candle jar was incubated for 24 hours at 37 ° C using a type A gas pack (MERCK). 10 μL of each of the tested media was added to Müller Hinton agar containing sheep blood and vitamin K and were counted by surface plate count (SPC) method. The total number of microorganisms was obtained in CFU / ml for each sample. The clinical results were analyzed by SPSS IBM software version 24 using Mann-Whitney test and Independent T test for comparison in three times and two groups. The microbiological results were analyzed by SPSS IBM software version 24 using Independent T test.

Results: Statistically significant decrease of bleeding on probing, probing depth, clinical attachment level and increase of gingival recession were seen over time in both groups. The greatest effect of treatment was noticed after two weeks of the intervention. No significant changes were observed in the periodontal parameters of the two groups during the subsequent three months. Improvement of periodontal parameters was not statistically significant in the chitosan group compared to the control group. In the microbiological part of the study, all study groups showed a significant decrease in the number of colonies compared to the positive control group. Additive use of laser in all three groups (Chitosan, Chitosan + Rose Bengal and Rose Bengal) significantly reduced the microbial activity of each group compared to the non-laser mode (p <0.05). The antibacterial effect of Chitosan + Rose Bengal was significantly higher than each of Chitosan and Rose Bengal alone (p <0.05). Conclusion: Although chitosan as a photoactivatable bioactive nanoparticle showed a decrease in the number of colonies, no additional benefit was seen in the clinical use of this compound along with mechanical debridement of first and second stage periodontitis.