Antimicrobial photodynamic therapy for the treatment of periodontitis and periâ implantitis: An American Academy of Periodontology best evidence review

Abstract

BackgroundThis systematic review evaluates the efficacy of antimicrobial photodynamic therapy (aPDT), as an adjunct to nonâ surgical or surgical therapy, on clinical and patientâ centered outcomes in patients with periodontitis or periâ implantitis.MethodsRandomized controlled trials (RCTs) with a followâ up duration ⠥ 3 months that evaluated mechanical root/implant surface debridement (i.e., scaling and root planing [SRP] or implant surface scaling [ISS]) versus SRP or ISS plus aPDT for the treatment of adult patients (⠥ 18 years old) with moderateâ toâ severe chronic (CP)/aggressive periodontitis (AgP) or periâ implantitis, respectively, were considered eligible for inclusion. The MEDLINE, EMBASE, and CENTRAL databases were searched for articles published up to and including March 2017. Randomâ effects metaâ analyses were used throughout the review using continuous data (i.e., mean changes from baseline), and pooled estimates were expressed as weighted mean differences with their associated 95% confidence intervals. Additionally, summaries are presented of the included RCTs, critical remarks of the literature, and evidence quality rating/strength of recommendation of laser procedures.ResultsOf 729 potentially eligible articles, 28 papers (26 studies) were included in the review. Individual study outcomes and four sets of metaâ analysis showed potential statistical significant benefit of aPDT in improving clinical attachment level (CAL) (nonâ surgical treatment of AgP) and probing depth (PD) (nonâ surgical treatment of AgP and CP). However, the comparative differences in clinical outcomes were modest (< 1 mm), and the level of certainty for different therapies was considered lowâ toâ moderate (i.e., more information would be necessary to allow for a reliable and definitive estimation of effect/magnitude of therapies on health outcomes). Overall, most of the strengths of clinical recommendations of aPDT were guided by the expert opinion.ConclusionsaPDT may provide similar clinical improvements in PD and CAL when compared with conventional periodontal therapy for both periodontitis and periâ implantitis patients. The restricted base of evidence for some treatment approaches and conditions precludes additional conclusions.