Chloro-aluminum phthalocyanine-mediated photodynamic therapy improves peri-implant parameters and crevicular fluid cytokine levels in cigarette smokers with chronic hyperglycemia.

Purpose: This clinical trial aimed to evaluate the effectiveness of chloroaluminum phthalocyanine-mediated photodynamic therapy (CAPC-PDT) as an adjunct to peri‑implant mechanical debridement (PID) in the treatment of peri‑implantitis in patients with chronic hyperglycemia and cigarette smoking.

Methods: The selected participants with peri‑implantitis were divided into two groups: Group I (n = 15) included hyperglycemic patients with no history of smoking and Group II (n = 15) included hyperglycemic patients with a history of smoking cigarettes. Both groups were further divided into two subgroups based on the type of therapy provided: PDT+PID and PID alone. Peri-implant bleeding on probing (PiBOP), peri‑implant pocket depth (PiPD), peri‑implant plaque scores (PiPS), and crestal bone loss (CBL) were assessed. Peri-implant crevicular fluid (PICF) was sampled for quantification of interleukin (IL)-1β and tumor necrosis factor-alpha (TNF-α) using an enzyme-linked immunosorbent assay. All assessments were performed at baseline and at three and six months.

Results: PDT+PID showed a higher reduction in PiBOP than PID alone in hyperglycemic/non-smoking participants (p<0.01). PDT+PID and PID show a significant reduction in PiBOP in smokers only at 6 months (p<0.05), with comparable differences between PDT+PID and PID (p>0.05). PDT+PID significantly reduced PiPD hyperglycemic/smoking patients at 3 and 6 months (p<0.05), whereas PID only produced a significant reduction in PiPD at 6 months in smoking patients (p<0.05). CBL alone with PDT+PID in both smokers and non-smokers showed a statistically significant reduction at 6 months follow-up (p<0.05). IL-1β was significantly reduced in hyperglycemic/non-smoking participants at 6 months follow-up with both PDT+PID and PID alone (p<0.01). This trend was also observed in cigarette smokers, with an additional short-term reduction in IL-1β at 3 months with PDT+PID (p<0.05). Only the PDT+PID group showed a significant reduction in TNF-a among cigarette smoking patients with chronic hyperglycemia at 6 months follow-up (p<0.05) CONCLUSION: Chloroaluminum phthalocyanine-mediated PDT proved effective in improving peri‑implant clinical outcomes and reducing cytokine levels in smoking patients with chronic hyperglycemia.