The aim of this review was to evaluate the clinical adjunctive effect of antimicrobial photodynamic therapy (aPDT) to scaling and root planing (SRP) when compared with SRP alone or in combination with placebo in the treatment of chronic periodontitis (CP) patients.

A search in the Medline, Cochrane Controlled Clinical Trial Register, Cochrane Database of Systematic Reviews, CINAHL, Science Direct, ISI Web of Knowledge and SCOPUS database was undertaken. This was supplemented by a manual search in wide range of periodontology journals and the reference lists of identified articles. Randomised controlled trials in humans affected by CP irrespective of its severity were included. Studies reporting additional treatments (e.g. local or systemic antimicrobial therapy, adjunctive laser therapy, periodontal surgical therapy) other than SRP + aPDT were excluded.   The primal outcomes were clinical attachment level (CAL) gain and probing depth (PD) reduction.

• 14 articles were included in the systematic review, four were split-mouth two- arm, three were split-mouth three-arm, two were parallel three-arm and five were parallel two-arm studies.
• 7 studies were considered to be at low risk of bias the remainder at high risk.
• The meta-analysis failed to show a significant PD reduction between SRP + aPDT and SRP (MD 0.12, 95% CI -0.08 to 0.33, p = 0.24,
• However, a significant PD reduction was observed in the sub-group of parallel studies (MD 0.23, 95% CI 0.07–0.40, p = 0.006) in favour of SRP + aPDT.
• No significant difference was found in the split-mouth studies subgroup (MD 0.05, 95% CI -0.30 to 0.40, p = 0.78).
• The results of the pooled analysis indicated that a high and significant CAL gain was present in favour of SRP + aPDT (MD 0.27 95% CI 0.12–0.42, p = 0.005).
• A larger amount of CAL gain was observed in the parallel studies subgroup, in favour of SRP + aPDT (MD 0.32, 95% CI 0.17–0.48, p < 0.0001),
• No significant differences were detected in the split-mouth studies subgroup (MD 0.15, 95% CI -0.21 to 0.50, p = 0.43).

The authors concluded

An evidence-based assessment of current literature suggested that the adjunctive use of aPDT could provide additional short-term benefits to SRP; however, these beneficial effects seemed to be modest and not stable over the time. Therefore, until the remaining issues are clarified, no clinical recommendation can be given.

Comment

We looked at a related review to this by the same authors in 2001 (Dental Elf 24^th Oct 2011), which had similar findings. Overall the analysis included 360 patients with between 10 -58 patients in the studies.

Links

Sgolastra F, Petrucci A, Severino M, Graziani F, Gatto R, Monaco A. Adjunctive photodynamic therapy to non-surgical treatment of chronic periodontitis: a systematic review and meta-analysis. J Clin Periodontol 2013; 40: 514–526. doi: 10.1111/jcpe.12094.

Dental Elf 24^th Oct 2011 – Some evidence to support antimicrobial photodynamic therapy in patients with chronic periodontitis