Clinical efficacy of photodynamic therapy and laser irradiation as an adjunct to open flap debridement in the treatment of chronic periodontitis: A systematic review and meta-analysis.

BACKGROUND: The aim of this systematic review and meta-analyses was to assess the quality of evidence and efficacy of antimicrobial photodynamic therapy (aPDT) and laser irradiation (LI) as an adjunct to open flap debridement (OFD) in the treatment of chronic periodontitis. METHODS: Electronic searches were conducted in databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) up to March 2019. Randomized clinical trials (RCTs) comparing clinical efficacy of either aPDT and/or LI, placebo, or no treatment were included. Primary outcomes included clinical attachment level (CAL), while secondary outcomes were reduction in probing depth (PD) and gingival recession (GR) depth. The weighted mean differences (WMD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using random effect model. RESULTS: Six RCTs were included. For aPDT studies, the overall mean difference for CAL gain (WMD = -0.61, 95% CI = -1.22 to -0.016, P = .044) and PD reduction (WMD = -1.79, 95% CI = -3.44 to -0.14, P = .034) was significant between aPDT and OFD groups at follow-up. No significant overall mean difference was observed for GR depth (WMD = 0.02, 95% CI = -0.75 to 0.79, P = .95). For LI studies, none of the clinical periodontal parameters including CAL gain (WMD = 0.23, 95% CI = -0.09 to 0.55, P = .159, Figure 3A), PD reduction (WMD = 0.31, 95% CI = -0.67 to 1.31, P = .52, Figure 3B) and GR depth (WMD = -0.34, 95% CI = -2.47 to 1.78, P = .74, Figure 3C) were found to be significant between LI and OFD groups at follow-up. CONCLUSION: With the limited data available, only aPDT as an adjunct to OFD showed superior results for clinical periodontal parameters compared to OFD alone in the treatment of chronic periodontitis. Further RCTs are warranted in order to obtain robust conclusions with regard to laser therapy.

Effectiveness of antimicrobial photodynamic therapy as an adjunct to open flap debridement in patients with aggressive periodontitis.

AIM: The aim of the present clinical trial was to evaluate the clinical efficacy of photodynamic therapy (PDT) as an adjunct to open flap debridement (OFD) in the treatment of generalized aggressive periodontitis (GAP). MATERIALS AND METHODS: The subjects recruited for the study were divided into two groups: 'control group' received treatment through OFD, whereas the test participants were treated with OFD and adjunctive PDT. The clinical periodontal parameters were plaque index (PI), full mouth probing depth (FMPD) and full mouth relative attachment loss (FMRA). The microbial levels of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) and Tannarella forsythia (Tf) were analyzed. All parameters were assessed at baseline and 3 months. STATISTICAL ANALYSIS: The observed values for all the parameters were reported in mean and standard deviation (mean ± SD). In order to analyse the mean values and inter-group comparisons, the Mann-Whitney U test was employed. The p-value was set at <0.05 to establish a significant difference among the reported values. RESULTS: A statistically significant improvement for BOP was observed in PDT group in comparison to the control group at 3 months only (p < 0.05). A significant reduction in the microbiological levels for Aa, Pg and Tf in both the study groups was observed. However, no significant differences in microbial levels were observed at any time point when the control and test groups were compared to each other. CONCLUSION: PDT in conjuction with OFD plays a significant role in reducing the microbial load and improving the clinical periodontal parameters in patients with GAP. Moreover, it is regarded as a safe treatment regimen as no side effects have been reported regarding its use in GAP.

Clinical and immunological peri-implant parameters among cigarette and electronic smoking patients treated with photochemotherapy: A randomized controlled clinical trial.

BACKGROUND: Although studies have been done that evaluated the effect of photodynamic therapy (PDT) in cigarette smokers and vapers, however, literature on the impact of these types of smoking on peri-implant parameters lack. The present clinical trial assessed the effectiveness of PDT as an adjunctive therapeutic modality in the treatment of peri-implant mucositis (p-iM) in individuals vaping e-cigs and cigarette smokers. METHODS: Individuals with p-iM were divided into three groups. (a) Group 1: Cigarette smokers with p-iM (b) Group 2: Vapers (e-cigarette smokers) with p-iM, (c) Group 3: Non-smokers with p-iM. Plaque index (PI), bleeding on probing (BOP) and probing depth (PD) were calculated. Pro-inflammatory biomarkers including matrix metalloproteinase (MMP)-8 and tumor necrosis factor-alpha (TNF-α) were quantified using enzyme linked immunosorbent assay. All assessments were performed at baseline (before treatment) and 12 weeks post treatment. Full mouth disinfection (FMD) was done with the ultrasonic scaler and copious irrigation. The photodynamic therapy (PDT) was done with a diode laser (wavelength: 670 nm, power: 150 mW, density: 1.1 W/cm2). Methylene blue photosensitizer (0.005% concentration) was incorporated inside the periimplant pockets (10 seconds at a depth of 3 mm), and the pockets were irradiated a flexible tip for one minute on the buccal and lingual surfaces. The session of PDT was performed only once at baseline. RESULTS: Twenty-five cigarette-smokers (Group 1), 21 electronic cigarette smokers (Group 2) and 25 never-smokers (Group 3) participated in the study. The mean age of the selected participants in groups 1, 2 and 3 was 29.5, 27.8, and 30.2 years, respectively. Statistically significant reduction in PI and PD parameters was observed on baseline and at 12 weeks in all groups. BOP significantly increased in group 1 and 2 at 12 weeks. A statistically significant reduction from baseline to 12 weeks was reported in the biomarker levels for all the study groups. CONCLUSION: PDT with adjunctive mechanical debridement reduced the plaque index and probing depth, while increased bleeding on probing, in addition to reducing pro-inflammatory biomarkers in tobacco smokers.

Efficacy of adjunctive photodynamic therapy on the clinical periodontal, HbA1c and advanced glycation end product levels among mild to moderate chronic periodontal disease patients with type 2 diabetes mellitus: A randomized controlled clinical trial.

AIMS: To evaluate the clinical periodontal, serum glycated haemoglobin (HbA1c) and levels of advanced glycation end-products (AGEs) in the gingival crevicular fluid (GCF) among patients with periodontitis and type 2 diabetes mellitus (DM) after photodynamic therapy (PDT) as an adjunct to full-mouth disinfection (FMD). MATERIALS AND METHODS: Thirty type 2 DM patients with mild to moderate periodontitis were divided into two main groups: Group-A receiving adjunctive PDT with FMD and Group-B receiving FMD alone. Full-mouth plaque index (PI), bleeding on probing (BOP), probing depth (PD), attachment level (AL) were recorded. Serum HbA1c was assessed among all participants using a HbA1c analyser kit. Levels of AGEs in GCF were determined using enzyme-linked immunosorbent assay. Clinical periodontal and metabolic parameters were assessed at baseline, 3 months and 6 months. Differences were compared using the Friedman test within the groups for different time points. Kruskal-Wallis test with Bonferroni correction test was applied for intragroup and multiple comparisons, respectively. RESULTS: All the clinical periodontal parameters showed significant reduction from baseline to 3 months (P < 0.05) and 6 months follow-up in both the groups (P < 0.01). Only PD showed statistically significant difference from baseline to 3 months in Group-A (P < 0.01). Mean percentage of HbA1c remained constant throughout the study period in both the groups. Mean level of AGEs significantly reduced in both the groups at all time-points. Mean AGEs level reduced slightly higher in Group-A compared to Group-B at 3 months follow-up. However, this difference was not statistically significant (P > 0.05). CONCLUSION: No additional benefit was seen in the improvement of clinical periodontal parameters and systemic (HbA1c levels) outcomes with PDT except that a minor reduction in the levels of AGEs in the GCF was observed with PDT in the short term.