Insufficient evidence for photodynamic therapy use in periodontitis

Abstract

Data sources: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Health and Psychosocial Instruments, HealthSTAR (OVID), Allied and Complementary Medicine and the International Pharmaceutical Abstracts. Abstracts from 2007 to 2009 of the annual meetings of the American Academy of Periodontology, International Association of Dental Research and the American Association of Dental Research.

Study selection: Randomised and quasi-randomised studies reported in any language comparing PDT as a primary or adjunctive therapy to no treatment, placebo or scaling and root planing (SRP). Eligible studies were those that included participants over 18 years of age and who had periodontitis, and where the primary outcome measurement was clinical attachment loss (CAL) and changes in probing depth.

Data extraction and synthesis: Two reviewers reviewed, assessed and rated study quality and extracted relevant data. It is not reported how these data were collated. The quality of included studies was assessed according to Cochrane risk of bias domains. Mean difference (MD) and 95% confidence intervals (CI) were extracted. Data were combined in a meta-analysis where possible using the random-effects model. Homogeneity was assessed using the Cochrane test and heterogeneity assessed using I(2).

Results: Five studies at moderate to high risk of bias were included. The studies differed markedly in design and were clinically heterogenous. Studies that compared PDT to no treatment found no difference in CAL whereas those that compared PDT plus SRP (n=26) to those receiving just SRP (n=26) gave a MD of 0.34 mm with 95% CI 0.05 to 0.63 mm. Three studies that compared PDT alone to SRP alone showed a reduction in probing depth in favour of SRP (MD -0.21, 95% CI -0.40-0.02). In three studies that compared PDT plus SRP to SRP alone the MD was 0.25 mm (95% CI: 0.04 to 0.45 mm).

Conclusions: There is insufficient evidence that photodynamic therapy as an independent treatment or as an adjunct to scaling and root planning is superior to SRP alone.