Treatments
PD, ARC
FOX, PERIODONTAL ABSCESS, PLAQUE
Patients were randomly assigned to the test or control group according to a computer-generated list without any restriction. Allocation concealment was assured by opaque, sealed envelopes prepared and sequentially numbered by a person not otherwise involved in the study. Each patient enrolled in the study was instructed to brush and to perform interdental cleaning once daily with interdental brushes. These instructions were reinforced at the re-evaluation visits depending on the plaque scores.At the first visit (day 0), all patients received a FMUD. The piezo-ceramic ultrasonic device (EMS, Electro Medical Systems, Nyon, Switzerland) with dedicated tips (Piezon A, P, PS, EMS, Nyon, Switzerland) was used under profuse water irrigation with power settings between 50 and 80% for 45–90 min. One week later (day 7), patients were randomly allocated to the test or to the control group, with patients not aware of the assignment group. In the test group, sites with initial PD >4 mm were treated with aPDT using a diode laser device and a photosensitizer solution. In particular, pockets were irrigated by a syringe loaded with an indocyanine green photosensitizer solution (Emundo®, Sweden&Martina, Due Carrare, Padova, Italy) at a concentration of 1 mg/ml. The photosensitizer solution was allowed to stay in the pockets for 2 min, and excess solution was washed out from the pockets before laser irradiation. Afterwards, a 300-μm bulb optical fibre of the 810 nm diode laser unit (Fox ARC, Sweden & Martina, Due Carrare, Italy) set at 300 mw in pulsed mode (100 ms ON/100 ms OFF) was inserted along the pocket and activated for 30 s with continuous vertical movements from the bottom of the pocket to the gingival margin. The patients in the control group were treated by the same operator and received the same treatment, irrigating the pockets with the photosensitizer solution and carrying inside the optical fibre with the laser kept it turned off mode. In both treatment groups, local anaesthesia was only applied when requested by the patient. The same treatment was repeated 3 weeks later (day 28) in both test and control groups. After completing the treatment phase, all teeth were polished supragingivally with a rubber cup and a low abrasive polishing paste (Nupro, Dentsply-Sirona, USA) at each follow-up visit. If during the follow-up period, any patient showed attachment loss of ≥2 mm in ≥4 teeth, or the presence of a periodontal abscess, he or she was excluded from the study and treated again with standard periodontal therapy. Data from these patients were analysed as if they had been dropped for other reasons (intention-to-treat analysis).