Efficacy of Adjunctive Antimicrobial Photodynamic Therapy to Mechanical Debridement in the Treatment of Peri‐implantitis or Peri‐implant Mucositis in Smokers: A Systematic Review and Meta‐analysis

Abstract

This systematic review and meta-analysis aimed to determine whether adjunctive use of antimicrobial photodynamic therapy (a-PDT) in peri-implant diseases improves clinical outcomes in smokers. An electronic search was performed in MEDLINE (through PubMed), Scopus, Cochrane Library, Embase, Web of Science and Google Scholar. The primary outcome measures were bleeding on probing (BOP) and pocket depth (PD). Plaque index (PI) was the secondary outcome. Four RCTs, (188 participants) comprised of 118 cigarette smokers, 38 E-cig smokers and 32 water pipe smokers with follow-up periods ranged from 6 weeks to 6 months were recruited. All trials applied diode laser in one session with wavelengths ranged from 660 to 670 nm. There was a significant difference between mechanical debridement (MD)+a-PDT and MD alone groups in PD (WMD = À1.26 mm, 95% CI: À2.19 to À0.32, P = 0.01) and PI (WMD = À10.60%, 95% CI: À14.46 to À6.74, P < 0.001) at 3-month follow-up. However, a great amount of heterogeneity was observed (PD: v 2 = 199.19, I 2 = 98%, P < 0.001 and PI: v 2 = 25.63, I 2 = 84.4%, P < 0.001). Due to methodological heterogeneity and small number of studies, this systematic review was unable to reach conclusive evidence in regards of adjunctive a-PDT efficacy in improving clinical parameters in smokers.

Efficacy of chemical approaches for implant surface decontamination in conjunction with sub‐marginal instrumentation, in the non‐surgical treatment of peri‐implantitis: A systematic review

“…The findings of the current systematic review are broadly in agreement with the relevant sections of previous systematic reviews (Schwarz et al, 2015; Ramamauskaite et al, 2021; Shahmohammadi et al, 2022). Schwarz and colleagues reported that “alternative/adjunctive measures may improve the efficacy over/of conventional non‐surgical treatments at peri‐implantitis sites” (Schwarz et al, 2015).…”

“…However, this conclusion was based mainly on studies in which the adjunctive measures concerned antibiotic therapy and not restricted to chemical approaches as in the current systematic review. More recently, another systematic review and meta-analysis, which specifically investigated the adjunctive use of photodynamic therapy, reported a significant benefit in terms of both PD and plaque index at 3-month follow-up over mechanical debridement alone (Shahmohammadi et al, 2022).…”

Efficacy of adjunctive photodynamic therapy to conventional mechanical debridement for peri-implant mucositis

“…Importantly, PDT does not result in scarring post-treatment and reduces the risk of recurrence [ 28 ], rendering it a highly promising therapeutic approach. While PDT has been explored as a treatment for p-iM [ 29 ], studies have confirmed its efficacy in this context [ 16 – 21 , 23 , 30 – 33 ]. However, there is still controversy regarding the effectiveness of PDT in improving certain indicators for pi-M patients due to variations in study populations, duration of irradiation, and the use of PSs.…”

Diode Laser as an Adjunctive Treatment for Peri-implant Mucositis: A Systematic Review and Meta-analysis

“…The findings of using lasers of various wavelengths in treating peri-implant diseases have been reported in several reviews, 28 , 29 , 55 , 56 , 57 , 58 , 59 but the outcomes of using diode lasers in the management of peri-implant mucositis was reported in 2 systematic reviews. 20 , 60 Both reviews 20 , 60 included studies that evaluated the adjunctive use of both photodynamic therapy and diode laser of different wavelengths and showed that both adjunctive therapies did not provide additional benefits, in agreement with our findings.…”