Photodynamic therapy as an adjunctive treatment for chronic periodontitis: meta-analysis

Sir John Walsh Research Institute, School of Dentistry, University of Otago, PO Box 647, Dunedin, New Zealand.
Lasers in Medical Science (Impact Factor: 2.49). 12/2009; 25(4):605-13. DOI: 10.1007/s10103-009-0744-6
Source: PubMed


Several antimicrobial strategies have been proposed in response to the alarming rise in antimicrobial resistance of periodontal pathogens. Antimicrobial photodynamic therapy (a-PDT) is a promising novel approach that has been used in several clinical applications including in the treatment of periodontal diseases. The aim of this review was to systematically investigate the effectiveness of a-PDT as an adjuvant treatment for chronic periodontitis. The guidelines of the Quality of Reporting of Meta-analyses (QUOROM) conference statement were followed in the preparation of this meta-analysis. An electronic search for randomized controlled trials (RCTs) that investigated the combined use of scaling and root planing (SRP) and a-PDT in comparison with SRP alone was performed without language restriction up to 1 October 2008. RevMan 5.0 software was used to analyze the data. A random effects model was chosen and standardized mean differences with 95% confidence intervals were calculated for continuous data. Four RCTs were included. The use of a-PDT in conjunction with SRP was associated with significantly greater attachment gain (mean difference 0.29, 95% confidence interval 0.08 to 0.50, p=0.007), and greater reduction in probing depth (mean difference 0.11, 95% confidence interval -0.12 to 0.35, p=0.35) at 12 weeks. However, the changes in gingival recession showed slight differences. This review and meta-analysis supported the potential improvements in clinical attachment level and probing depth provided by the combined approach (SRP with a-PDT). Nevertheless, the findings of this review should be interpreted with caution given the small number of included studies.

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    • "Failed endodontic treatment often leaves bacteria within the root canal system. Photoactivated disinfection (PAD) is a novel method that is used to treat endodontic inflammation and other inflammatory diseases, such as periodontitis [3] [4]. Photodynamic therapy (PDT) was originally developed as a therapy for pre-malignant diseases, tumors and other oral lesions [5]; however, PAD is increasingly being used in the field of dentistry [6]. "
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    ABSTRACT: Objective: To investigate the lethal activity of photoactivated disinfection (PAD) on Enterococcus faecalis (ATCC 29212) and mixed populations of aerobic or anaerobic bacteria in infected root canals using a diode laser after the application of a photosensitizer (PS). Materials and methods: First, the bactericidal activity of a low power diode laser (200 mW) against E. faecalis ATCC 29212 pre-treated with a PS (toluidine blue) for 2 min were examined after different irradiation times (30 s, 60 s and 90 s). The bactericidal activity in the presence of human serum or human serum albumin (HSA) was also examined. Second, root canals were infected with E. faecalis or with mixed aerobic or anaerobic microbial populations for 3 days and then irrigated with 1.5% sodium hypochlorite and exposed to PAD for 60 s. Results: Photosensitization followed by laser irradiation for 60 s was sufficient to kill E. faecalis. Bacteria suspended in human serum (25% v/v) were totally eradicated after 30 s of irradiation. The addition of HSA (25 mg/ml or 50 mg/ml) to bacterial suspensions increased the antimicrobial efficacy of PAD after an irradiation time of 30 s, but no longer. The bactericidal effect of sodium hypochlorite was only enhanced by PAD during the early stages of treatment. PAD did not enhance the activity of sodium hypochlorite against a mixture of anaerobic bacteria. Conclusions: The bactericidal activity of PAD appears to be enhanced by serum proteins in vitro, but is limited to bacteria present within the root canal.
    Acta odontologica Scandinavica 03/2014; 72(8). DOI:10.3109/00016357.2014.898087 · 1.03 Impact Factor
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    • "These findings suggest that aPDT could be potentially advantageous in periodontal therapy (Azarpazhooh et al. 2010), as well as in the treatment of peri-implantitis (Haas et al. 2000) and endodontic infections (Garcez et al. 2007). However, studies conducted on humans have reported contrasting results (Braun et al. 2008, Christodoulides et al. 2008, Chondros et al. 2009, Lulic et al. 2009), and systematic reviews (Atieh 2010, Azarpazhooh et al. 2010, Sgolastra et al. 2013) have not shown any adjunctive effect of aPDT. Nevertheless, this lack of effect in the meta-analyses might have been due to the paucity of available studies (Atieh 2010, Azarpazhooh et al. 2010) and potential methodological biases, such as the inclusion of only parallel-group studies (Sgolastra et al. 2013). "
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    ABSTRACT: To investigate the efficacy of antimicrobial photodynamic therapy (aPDT) adjunctive to scaling root planing (SRP) in patients with chronic periodontitis. A meta-analysis was conducted according to the PRISMA statement and Cochrane Collaboration recommendations. Two independent reviewers performed an extensive literature search and manual search on seven databases. Mean differences (MD) and 95% confidence intervals (CI) were calculated for clinical attachment level (CAL) gain and probing depth (PD) reduction. The I(2) test was used for inter-study heterogeneity. Publication bias was examined by Egger's regression test and the trim-and-fill method. Sensitivity analysis of 14 randomized clinical trials (RCTs) revealed differences in PD reduction (MD 0.19, 95% CI 0.07-0.31, p = 0.002) and CAL gain (MD 0.37, 95% CI 0.26-0.47, p < 0.0001) in favour of SRP + aPDT, with no evidence of heterogeneity. Subgroup analysis revealed the absence of heterogeneity in RCTs, with high risk of bias for PD reduction and CAL gain. No evidence of publication bias was detected. The use of adjunctive aPDT to conventional SRP provides short-term benefits. The evidence to support its clinical medium/long-term efficacy is insufficient. Further high-quality RCTs are needed to investigate the influence of potential confounders on the efficacy of adjunctive aPDT.
    Journal Of Clinical Periodontology 05/2013; 40(5):514-26. DOI:10.1111/jcpe.12094 · 4.01 Impact Factor
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    • "Atieh6 (2010), after a systematic review and meta-analysis concluded that the combined use of PDT with conventional SRP may provide additional improvements in CAL, PD and other clinical measures in the treatment of chronic periodontitis. However, it is still questionable if this improvement is clinically meaningful due to the limited amount of data. "
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    ABSTRACT: Background: Photodynamic therapy (PDT) is a method of microbial reduction which can benefit periodontal treatment in areas of difficult access, such as deep pockets and furcations. The aim of this randomized controlled clinical trial was to evaluate the effects of PDT as an adjunct to full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis. Material and Methods: Twenty-two patients with at least one pocket with a probing depth (PD) of ≥7 mm and one pocket with a PD of ≥5 mm and bleeding on probing (BOP) on each side of the mouth were included, characterizing a split mouth design. The control group underwent full-mouth ultrasonic debridement and the test group received the same treatment associated with PDT. The PDT was performed on only one side of the mouth and the initial step consisted of subgingival irrigation with 0.005% methylene blue dye. Two minutes after applying the photosensitizer, the low power laser - AsGaAl (Photon Lase III - PL7336, DMC, São Carlos -São Paulo, Brazil) was applied (660 nm, 100 mW, 9 J, 90 seconds per site, 320 J/cm2, diameter tip 600 µm).The following clinical parameters were evaluated: plaque index, gingival index, BOP, gingival recession (GR), PD, and clinical attachment level (CAL). All parameters were collected before, 1, 3 and 6 months after treatment. Results: An improvement in BOP, PD and CAL was observed after treatment, in both groups, but without any difference between them. After 6 months, the PD decreased from 5.11±0.56 mm to 2.83±0.47 mm in the test group (p<0.05) and from 5.15±0.46 mm to 2.83±0.40 mm in the control group (p<0.05). The CAL changed, after 6 months, from 5.49±0.76 mm to 3.41±0.84 mm in the test group (p<0.05) and from 5.53±0.54 to 3.39±0.51 mm in the control group (p<0.05). Conclusion: Both approaches resulted in significant clinical improvements in the treatment of severe chronic periodontits, however, the PDT did not provide any additional benefit to those obtained with full-mouth ultrasonic debridement used alone.
    Journal of applied oral science: revista FOB 03/2013; 21(2). DOI:10.1590/1678-7757201302366 · 0.92 Impact Factor
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