Is Antimicrobial Photodynamic Therapy Effective for Microbial Load Reduction in Peri‐implantitis Treatment? A Systematic Review and Meta‐Analysis

Abstract

The systematic review and meta-analysis were undertaken to evaluate the effectiveness of antimicrobial photodynamic therapy (aPDT) in the microbiological alteration beneficial to peri-implantitis treatment. This study is registered with PROSPERO, number CRD42017064215. Bibliographic databases including Cochrane Library, Web of Science, Scopus and PubMed were searched from inception to 8 January 2017. The search strategy was assembled from the following MeSH Terms: "Photochemotherapy," "Dental Implants" and "Peri-Implantitis." Unspecific free-text words and related terms were also included. The Cochrane Collaboration's tool was used to evaluate the risk of bias of included studies. The random-effect model was chosen, and heterogeneity was evaluated using the I test. Three studies met the inclusion criteria. Meta-analysis demonstrated an association between aPDT and reduction in viable bacteria counts for: Aggregatibacter actinomycetemcomitans (OR = 1.31; confidence interval = 1.13, 1.49; P < 0.00001), Porphyromonas gingivalis (OR = 4.08; confidence interval = 3.22, 4.94; P < 0.00001) and Prevotella intermedia (OR = 1.66; confidence interval = 1.06, 2.26; P < 0.00001). A aPDT appears to be effective in bacterial load reduction in peri-implantitis and has a positive potential as an alternative therapy for peri-implantitis.

Dental Implants Surface in vitro Decontamination Protocols

“…In the last decades, lasers associated with photosensitizing agents, in antimicrobial photodynamic therapy (aPDT), have been used as a chemical method for dental implant surface decontamination with promising results. 19,28 The aPDT is a minimally invasive, nontoxic, and safe method 14 based on the use of a photosensitizer, usually a dye activated by light with a specific wavelength, which can kill bacteria by generating highly reactive oxygen species. 14,29 The anti-infective treatment with aPDT uses a low-level laser after application of photosensitizing agents like toluidine blue and methylene blue or indocyanine green, 13,30 the only three photosensitizers clinically approved for use in humans in combination with light.…”

“…19,28 The aPDT is a minimally invasive, nontoxic, and safe method 14 based on the use of a photosensitizer, usually a dye activated by light with a specific wavelength, which can kill bacteria by generating highly reactive oxygen species. 14,29 The anti-infective treatment with aPDT uses a low-level laser after application of photosensitizing agents like toluidine blue and methylene blue or indocyanine green, 13,30 the only three photosensitizers clinically approved for use in humans in combination with light. 30,31 Recent studies have shown that aPDT seems to be effective in reducing bacterial load in peri-implantitis and is a potential alternative therapy.…”

Influence of In-Situ Electrochemical Oxidation on Implant Surface and Colonizing Microorganisms Evaluated by Scanning Electron Microscopy

“…A plethora of non-surgical [5] and surgical [6,7] treatment protocols have been established indicating that an optimal strategy with successful and predictable outcomes does not yet exist. Techniques for dental implant decontamination used alone or in combination include mechanical debridement [8], use of antimicrobial agents including the local or systemic application of antibiotics [9,10,11,12], laser application [13,14], photodynamic therapy [15,16,17], cold plasma treatment [18,19] and air particle abrasion [20,21,22,23] (for review, see [24]).…”

Electrochemical Disinfection of Dental Implants Experimentally Contaminated with Microorganisms as a Model for Periimplantitis

“…The microorganisms applied included yeasts (Candida albicans, Candida dubliniensis), Gram-negative (Roseomonas mucosa) and Gram-positive bacteria (Enterococcus faecalis, Staphylococcus epidermidis, Streptococcus sanguinis), including spore-forming bacteria (Bacillus pumilus, Bacillus subtilis) ( Table 1). The microorganisms were chosen based on their robustness and occurrence in cases of infected root canals [31,32] as well as in cases of peri-implantitis [33,34]. Often found members of the genera Prevotella and Treponema were not included in the study, since these anaerobic and microaerophilic bacteria are highly oxygen-sensitive and less resistant against reactive oxygen species and even atmospheric oxygen concentrations.…”

“…A broad variety of techniques for the disinfection of dental implants has been described in the literature [26]. These include mechanical instrumentation [28,29], chemical and antimicrobial agents [30], treatment with local or systemic antibiotics [17,29,31], laser application [32], photodynamic therapy [18,33,34], cold plasma treatment [35,36] and air abrasion [37][38][39][40]. In many instances, only combinations of different disinfection techniques have been shown to be effective [36,[40][41][42], with mechanical debridement bearing the risk of implant surface alterations [43].…”