Adjunctive laser or antimicrobial photodynamic therapy to non‐surgical mechanical instrumentation in patients with untreated periodontitis: A systematic review and meta‐analysis

Abstract

Aim: To compare the adjunctive effects of lasers or antimicrobial photodynamic therapy (aPDT) to non-surgical mechanical instrumentation alone in untreated periodontitis patients. Materials and Methods: Two focused questions were addressed using the Population, Intervention, Comparison and Outcome criteria as follows: in patients with untreated periodontitis, (a) does laser application provide adjunctive effects on probing pocket depth (PPD) changes compared with non-surgical instrumentation alone? and (b) does application of aPDT provide adjunctive effects on PPD changes compared with non-surgical instrumentation alone? Both randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) were included. Results of the meta-analysis are expressed as weighted mean differences (WMD) and reported according to the PRISMA guidelines. Results: Out of 1,202 records, 10 articles for adjunctive laser and 8 for adjunctive aPDT were included. With respect to PPD changes, 1 meta-analysis including 2 articles (total n = 42; split-mouth design) failed to identify a statistically significant difference (WMD = 0.35 mm; 95%CI: −0.04/0.73; p = .08) in favour of adjunctive aPDT (wavelength range 650-700 nm). In terms of adjunctive laser application, a high variability of clinical outcomes at 6 months was noted. Two articles included patient-reported outcomes and 10 reported on the presence/absence of harms/adverse effects. Conclusions: Available evidence on adjunctive therapy with lasers and aPDT is limited by (a) the low number of controlled studies and (b) the heterogeneity of study designs. Patient-reported benefits remain to be demonstrated.

Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline

“…For this guideline, a total of 15 systematic reviews (SRs) were conducted to support the guideline development process (Carra et al., 2020; Dommisch, Walter, Dannewitz, & Eickholz, 2020; Donos et al., 2019; Figuero, Roldan, et al., 2019; Herrera et al., 2020; Jepsen et al., 2019; Nibali et al., 2019; Polak et al., 2020; Ramseier et al., 2020; Salvi et al., 2019; Sanz‐Sanchez et al., 2020; Slot, Valkenburg, & van der Weijden, 2020; Suvan et al., 2019; Teughels et al., 2020; Trombelli et al., 2020). The corresponding manuscripts are published within this special issue of the Journal of Clinical Periodontology.…”

Efficacy of laser monotherapy or non-surgical mechanical instrumentation in the management of untreated periodontitis patients. A systematic review and meta-analysis

“…Despite reports of positive outcomes on the use of Er:YAG lasers in the management of untreated periodontitis, clinically relevant benefits for the patient need to be systematically appraised. Outcomes of a recent systematic review by our group focused on the combined nonsurgical therapy with laser and mechanical instrumentation and failed to indicate adjunctive benefits of laser application in the management of untreated periodontitis when compared with non-surgical mechanical instrumentation alone [20]. However, the potential benefits of laser monotherapy in the management of untreated periodontitis remain to be investigated.…”

Laser parameters in systematic reviews

“…Laser devices have been improving each year, and their effects are better understood in the last 10 years.A systematic review and meta-analysis, about non-surgical periodontal treatment with lasers, was recently published in Journal of Clinical Periodontology (Salvi et al, 2020). I totally agree with the first part which discussed the effect of high-intensity lasers as adjunct treatment for periodontitis (Salvi et al, 2020). Indeed, there is lack…”