Rosebengal Assisted Antimicrobial Photodynamic Therapy as an Adjunct To Mechanical Debridement In Non Surgical Management Of Periimplantitis- A Randomised Control Trial.

Peri-implantitis refers to a localized infection that triggers inflammation in soft tissues and leads to bone deterioration around a surgically integrated implant in use. The causes of this implant-related infection are influenced by factors such as the condition of the tissue surrounding the implant, the design of the implant itself, its surface roughness, external shape, and excessive mechanical stress. The primary cause  behind implant failure are typically spiral-shaped bacteria and mobile variants of Gram-negative anaerobic bacteria, unless the issue stems solely from mechanical strain. Over the years, lasers have been utilized in the field of periodontology to disinfect the periodontal pockets since they possess exceptionally good bactericidal capabilities. By causing heat denaturation, direct ablation, or destruction of bacterial cells, the lasers possess a bactericidal effect. An unintentional discovery made in the early 20th century, antimicrobial photodynamic therapy (a-PDT) is used in medicine to inactivate cells using light. The three main components of antimicrobial photodynamic treatment are oxygen, nontoxic photosensitizers, and a source of visible light. The principle behind its use is when a suitable light of a specific wavelength when irradiated can activate the photosensitizes by producing high reactive state of oxygen called as singlet oxygen which reacts with the surrounding cells. The reactive oxygen species damage the cell wall of the microorganisms. This happens in a limited space leading to localized response. There are various photosensitizing agents like toluidine blue,  methylene blue, erythrosine, hematoporphyrin, chlorine and xanthene dyes. Rose bengal (RB) dye, a xanthene derivate is a potent photosensitizing agent, that once activated transfer this energy directly to oxygen, resulting in the formation of singlet oxygen. It has beendemonstrated as a potent photosensitizer used to eliminate Candida albicans, Streptococcus sanguis and Streptococcus mutans. It has also been proved in an in vitro study, to be effective against periodontopathogens like Porphyromonas gingivalis. However, there are no clinical studies assessing the efficiency of rose bengal mediated photodynamic therapy in treating peri implantitis . In this context, the present randomized controlled clinical trial has been carried out to ascertain the efficiency of rose bengal mediated photodynamic therapy as an adjunct to non-surgical management of peri implantitis.