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Antimicrobial photodynamic therapy for the treatment of periodontitis and peri‐implantitis: An American Academy of Periodontology best evidence review
Author(s) -
Chambrone Leandro,
Wang HomLay,
Romanos Georgios E.
Publication year - 2018
Publication title -
journal of periodontology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.036
H-Index - 156
eISSN - 1943-3670
pISSN - 0022-3492
DOI - 10.1902/jop.2017.170172
Subject(s) - medicine , scaling and root planing , periodontology , peri implantitis , chronic periodontitis , randomized controlled trial , periodontitis , dentistry , meta analysis , medline , debridement (dental) , confidence interval , photodynamic therapy , aggressive periodontitis , implant , surgery , chemistry , organic chemistry , political science , law
Background This systematic review evaluates the efficacy of antimicrobial photodynamic therapy (aPDT), as an adjunct to non‐surgical or surgical therapy, on clinical and patient‐centered outcomes in patients with periodontitis or peri‐implantitis. Methods Randomized controlled trials (RCTs) with a follow‐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 moderate‐to‐severe chronic (CP)/aggressive periodontitis (AgP) or peri‐implantitis, respectively, were considered eligible for inclusion. The MEDLINE, EMBASE, and CENTRAL databases were searched for articles published up to and including March 2017. Random‐effects meta‐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. Results Of 729 potentially eligible articles, 28 papers (26 studies) were included in the review. Individual study outcomes and four sets of meta‐analysis showed potential statistical significant benefit of aPDT in improving clinical attachment level (CAL) (non‐surgical treatment of AgP) and probing depth (PD) (non‐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 low‐to‐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. Conclusions aPDT may provide similar clinical improvements in PD and CAL when compared with conventional periodontal therapy for both periodontitis and peri‐implantitis patients. The restricted base of evidence for some treatment approaches and conditions precludes additional conclusions.