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

Snehal Dalvi,Stefano Benedicenti,Reem Hanna,Tudor Sălăgean,Ioana Roxana Bordea

doi:10.3390/pharmaceutics13060836

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.

Highlights

Antimicrobial Photodynamic therapy involves photo-excitation, which occurs when a photosensitizer (PS) dye is illuminated by a light of a matched wavelength, resulting in its activation and stimulation of a phototoxic response in the presence of ambient oxygen [1]
The efficacy of Antimicrobial Photodynamic therapy (aPDT) in improving treatment outcomes when it is utilized in the non-surgical management of periodontitis remains debatable
36 studies were excluded due to following reasons: Smokers were included or smoking details were not provided in 12 studies [23,35,36,37,38,39,40,41,42,43,44,45]; Laser or LLLT was utilized, as an adjunct to scaling and root planing (SRP) in eight studies [46,47,48,49,50,51,52,53]; light emitting diodes (LEDs)-aPDT was performed in seven studies [54,55,56,57,58,59,60]; aPDT was used in management of residual pockets in four studies [61,62,63,64]

Summary

Introduction

Antimicrobial Photodynamic therapy (aPDT) involves photo-excitation, which occurs when a photosensitizer (PS) dye is illuminated by a light of a matched wavelength, resulting in its activation and stimulation of a phototoxic response in the presence of ambient oxygen [1]. It has been persistently observed that bacterial recolonizations of Aggregatibacter actinomycetemcomitans (A.a) occur in periodontal pockets even after scaling and root planing (SRP) [2]. Aggressive periodontitis (AgP) is frequently associated with fewer local etiologic factors; it is believed that the affected patients are more likely to benefit from the antimicrobial effect of aPDT [3]. Chronic periodontitis (CP) patients usually have complex and thick deposits of polymicrobial communities on the affected root surfaces [4]. This may hamper penetration of PS, thereby reducing its effect and leading to an increase in the ‘red complex’ bacterial counts within a short period of time, resulting in a disease relapse [5]. The concept of replacing conventional SRP with aPDT is a controversial one with several imperative demerits, as enlisted above

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