Effectiveness of Antimicrobial Photodynamic Therapy in the Treatment of Periodontitis: A Systematic Review and Meta-Analysis of In Vivo Human Randomized Controlled Clinical Trials

Abstract

This systematic review and meta-analysis evaluated antimicrobial photodynamic therapy (aPDT) efficacy in periodontitis. The review protocol was conducted in accordance with PRISMA statements, Cochrane Collaboration recommendations and is registered in PROSPERO (CRD 42020161516). Electronic and hand search strategies were undertaken to gather data on in vivo human RCTs followed by qualitative analysis. Differences in probing pocket depth (PPD) and clinical attachment level (CAL) were calculated with 95% confidence intervals and pooled in random effects model at three and six months. Heterogeneity was analyzed, using Q and I2 tests. Publication bias was assessed by visual examination of the funnel plot symmetry. Sixty percent of 31 eligible studies showed a high risk of bias. Meta-analysis on 18 studies showed no additional benefit in split mouth studies in terms of PPD reduction (SMD 0.166; 95% CI −0.278 to 0.611; P = 0.463) and CAL gain (SMD 0.092; 95% CI −0.013 to 0.198; P = 0.088). Similar findings noted for parallel group studies; PPD reduction (SMD 0.076; 95% CI −0.420 to 0.573; P = 0.763) and CAL gain (SMD 0.056; 95% CI −0.408 to 0.552; P = 0.745). Sensitivity analysis minimized heterogeneity for both outcome variables; however, intergroup differences were not statistically significant. Future research should aim for well-designed RCTs in order to determine the effectiveness of aPDT.

Effects of Laser Therapy on Periodontal Status in Adult Patients Undergoing Orthodontic Treatment

“…Dalvi et al, following a systematic review and meta-analysis, concluded that the efficacy of photodynamic therapy in improving treatment outcomes, when used in the non-surgical management of periodontitis, remains questionable. However, the results from most of the included studies demonstrated the efficacy of photodynamic therapy and that its role is more pronounced when combined with mechanical therapy (SRP) than when alone [ 40 ].…”

Utilization of Laser Wavelengths in Periodontitis and Periimplantitis

“…Inside the periodontal pocket for non-surgical therapy, we use a diode near-infrared laser with a wavelength between 800nm-980nm for coagulating gingivae (epithelial ablation inside the pocket) as an adjunct to SRP. Additionally, it results in complete removal of the inflamed epithelium and decreases the amount of pro-inflammatory agents [9,12,[28][29][30][31][32][33][34][35][36]. Appropriate laser wavelengths, with suitable protocols, probably can improve the periodontal status for a more extended period and likely limit the use of antibiotics.…”

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“…As the diode laser family is predominantly absorbed by mainly haemoglobin and pigmented bacteria and poorly absorbed by hydroxyapatite in teeth and bone, it is considered a safe and suitable treatment modality in sulcular debridement [38,39]. The photonic energy of an ablative diode laser in the diseased periodontal pocket results in various beneficial effects [35,37,[40][41][42][43][44][45].…”