Clinical and immunological peri-implant parameters among cigarette and electronic smoking patients treated with photochemotherapy: A randomized controlled clinical trial

Background: Although studies have been done that evaluated the effect of photodynamic therapy (PDT) in cigarette smokers and vapers, however, literature on the impact of these types of smoking on peri-implant parameters lack. The present clinical trial assessed the effectiveness of PDT as an adjunctive therapeutic modality in the treatment of peri-implant mucositis (p-iM) in individuals vaping e-cigs and cigarette smokers. Methods: Individuals with p-iM were divided into three groups. (a) Group 1: Cigarette smokers with p-iM (b) Group 2: Vapers (e-cigarette smokers) with p-iM, (c) Group 3: Non-smokers with p-iM. Plaque index (PI), bleeding on probing (BOP) and probing depth (PD) were calculated. Pro-inflammatory biomarkers including matrix metalloproteinase (MMP)-8 and tumor necrosis factor-alpha (TNF-alpha) were quantified using enzyme linked immunosorbent assay. All assessments were performed at baseline (before treatment) and 12 weeks post treatment. Full mouth disinfection (FMD) was done with the ultrasonic scaler and copious irrigation. The photodynamic therapy (PDT) was done with a diode laser (wavelength: 670 nm, power: 150 mW, density: 1.1 W/cm2). Methylene blue photosensitizer (0.005% concentration) was incorporated inside the periimplant pockets (10 seconds at a depth of 3 mm), and the pockets were irradiated a flexible tip for one minute on the buccal and lingual surfaces. The session of PDT was performed only once at baseline. Results: Twenty-five cigarette-smokers (Group 1), 21 electronic cigarette smokers (Group 2) and 25 never-smokers (Group 3) participated in the study. The mean age of the selected participants in groups 1, 2 and 3 was 29.5, 27.8, and 30.2 years, respectively. Statistically significant reduction in PI and PD parameters was observed on baseline and at 12 weeks in all groups. BOP significantly increased in group 1 and 2 at 12 weeks. A statistically significant reduction from baseline to 12 weeks was reported in the biomarker levels for all the study groups. Conclusion: PDT with adjunctive mechanical debridement reduced the plaque index and probing depth, while increased bleeding on probing, in addition to reducing pro-inflammatory biomarkers in tobacco smokers.