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Meta-Analysis
. 2024 Jul 12;7(7):CD011778.
doi: 10.1002/14651858.CD011778.pub2.

Adjunctive antimicrobial photodynamic therapy for treating periodontal and peri-implant diseases

Pia-Merete Jervøe-Storm  1 , Jennifer Bunke  1 , Helen V Worthington  2 , Ian Needleman  3 , Raluca Cosgarea  1   4   5 , Laura MacDonald  2 , Tanya Walsh  2 , Sharon R Lewis  2 , Søren Jepsen  1
Affiliations
Meta-Analysis

Adjunctive antimicrobial photodynamic therapy for treating periodontal and peri-implant diseases

Pia-Merete Jervøe-Storm et al. Cochrane Database Syst Rev. .

Abstract

Background: Periodontitis and peri-implant diseases are chronic inflammatory conditions occurring in the mouth. Left untreated, periodontitis progressively destroys the tooth-supporting apparatus. Peri-implant diseases occur in tissues around dental implants and are characterised by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. Treatment aims to clean the pockets around teeth or dental implants and prevent damage to surrounding soft tissue and bone, including improvement of oral hygiene, risk factor control (e.g. encouraging cessation of smoking) and surgical interventions. The key aspect of standard non-surgical treatment is the removal of the subgingival biofilm using subgingival instrumentation (SI) (also called scaling and root planing). Antimicrobial photodynamic therapy (aPDT) can be used an adjunctive treatment to SI. It uses light energy to kill micro-organisms that have been treated with a light-absorbing photosensitising agent immediately prior to aPDT.

Objectives: To assess the effects of SI with adjunctive aPDT versus SI alone or with placebo aPDT for periodontitis and peri-implant diseases in adults.

Search methods: We searched the Cochrane Oral Health Trials Register, CENTRAL, MEDLINE, Embase, two other databases and two trials registers up to 14 February 2024.

Selection criteria: We included randomised controlled trials (RCTs) (both parallel-group and split-mouth design) in participants with a clinical diagnosis of periodontitis, peri-implantitis or peri-implant disease. We compared the adjunctive use of antimicrobial photodynamic therapy (aPDT), in which aPDT was given after subgingival or submucosal instrumentation (SI), versus SI alone or a combination of SI and a placebo aPDT given during the active or supportive phase of therapy.

Data collection and analysis: We used standard Cochrane methodological procedures, and we used GRADE to assess the certainty of the evidence. We prioritised six outcomes and the measure of change from baseline to six months after treatment: probing pocket depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL), gingival recession (REC), pocket closure and adverse effects related to aPDT. We were also interested in change in bone level (for participants with peri-implantitis), and participant satisfaction and quality of life.

Main results: We included 50 RCTs with 1407 participants. Most studies used a split-mouth study design; only 18 studies used a parallel-group design. Studies were small, ranging from 10 participants to 88. Adjunctive aPDT was given in a single session in 39 studies, in multiple sessions (between two and four sessions) in 11 studies, and one study included both single and multiple sessions. SI was given using hand or power-driven instrumentation (or both), and was carried out prior to adjunctive aPDT. Five studies used placebo aPDT in the control group and we combined these in meta-analyses with studies in which SI alone was used. All studies included high or unclear risks of bias, such as selection bias or performance bias of personnel (when SI was carried out by an operator aware of group allocation). We downgraded the certainty of all the evidence owing to these risks of bias, as well as for unexplained statistical inconsistency in the pooled effect estimates or for imprecision when evidence was derived from very few participants and confidence intervals (CI) indicated possible benefit to both intervention and control groups. Adjunctive aPDT versus SI alone during active treatment of periodontitis (44 studies) We are very uncertain whether adjunctive aPDT during active treatment of periodontitis leads to improvement in any clinical outcomes at six months when compared to SI alone: PPD (mean difference (MD) 0.52 mm, 95% CI 0.31 to 0.74; 15 studies, 452 participants), BOP (MD 5.72%, 95% CI 1.62 to 9.81; 5 studies, 171 studies), CAL (MD 0.44 mm, 95% CI 0.24 to 0.64; 13 studies, 414 participants) and REC (MD 0.00, 95% CI -0.16 to 0.16; 4 studies, 95 participants); very low-certainty evidence. Any apparent differences between adjunctive aPDT and SI alone were not judged to be clinically important. Twenty-four studies (639 participants) observed no adverse effects related to aPDT (moderate-certainty evidence). No studies reported pocket closure at six months, participant satisfaction or quality of life. Adjunctive aPDT versus SI alone during supportive treatment of periodontitis (six studies) We were very uncertain whether adjunctive aPDT during supportive treatment of periodontitis leads to improvement in any clinical outcomes at six months when compared to SI alone: PPD (MD -0.04 mm, 95% CI -0.19 to 0.10; 3 studies, 125 participants), BOP (MD 4.98%, 95% CI -2.51 to 12.46; 3 studies, 127 participants), CAL (MD 0.07 mm, 95% CI -0.26 to 0.40; 2 studies, 85 participants) and REC (MD -0.20 mm, 95% CI -0.48 to 0.08; 1 study, 24 participants); very low-certainty evidence. These findings were all imprecise and included no clinically important benefits for aPDT. Three studies (134 participants) reported adverse effects: a single participant developed an abscess, though it is not evident whether this was related to aPDT, and two studies observed no adverse effects related to aPDT (moderate-certainty evidence). No studies reported pocket closure at six months, participant satisfaction or quality of life.

Authors' conclusions: Because the certainty of the evidence is very low, we cannot be sure if adjunctive aPDT leads to improved clinical outcomes during the active or supportive treatment of periodontitis; moreover, results suggest that any improvements may be too small to be clinically important. The certainty of this evidence can only be increased by the inclusion of large, well-conducted RCTs that are appropriately analysed to account for change in outcome over time or within-participant split-mouth study designs (or both). We found no studies including people with peri-implantitis, and only one study including people with peri-implant mucositis, but this very small study reported no data at six months, warranting more evidence for adjunctive aPDT in this population group.

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Conflict of interest statement

  1. Pia‐Merete Jervøe‐Storm: none known.

  2. Jennifer Bunke: none known.

  3. Helen V Worthington: none known.

  4. Raluca Cosgarea: is an author of one of the included trials (Cosgarea 2021), but did not conduct the risk of bias assessment for that trial.

  5. Ian Needleman: has received funding for lectures and research from industry related to oral hygiene products, periodontal diseases and oral health as follows: clinical practice guideline groups with the European Federation of Periodontology (other IP), Procter and Gamble (independent contractor), NHS England (independent contractor), BrickBuilt Tecnologies (grant/contract and stock), private practice (independent contractor), research investigating patient involvement in periodontitis‐diabetes studies (other IP) and GlaxoSmithKline (grant/contract).

  6. Laura MacDonald: none known.

  7. Tanya Walsh: former Statistical Editor for Cochrane Oral Health; she has had no role in the editorial process for this review.

  8. Sharon Lewis: former Deputy Co‐ordinating Editor of Cochrane Bone, Joint and Muscle Trauma. SL was not involved in editing this review. SL declares no other conflicts.

  9. Søren Jepsen: none known.

Helen Worthington, Ian Needleman and Laura MacDonald are editors with Cochrane Oral Health but were not involved in the editorial processing of this review.

Figures

1
1
Study selection process
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. We did not complete risk of bias assessment for 3 studies (6%), indicated by blank (white) space at the right of the graph
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study. Blank spaces indicate that risk of bias assessment was not completed; we did not use any outcome data for these studies in the review.
1.1
1.1. Analysis
Comparison 1: Adjunctive aPDT versus control during active periodontal treatment (3‐month and 6‐month follow‐up), Outcome 1: PPD (change from baseline (mm)); 3 months
1.2
1.2. Analysis
Comparison 1: Adjunctive aPDT versus control during active periodontal treatment (3‐month and 6‐month follow‐up), Outcome 2: PPD (change from baseline (mm)); 6 months
1.3
1.3. Analysis
Comparison 1: Adjunctive aPDT versus control during active periodontal treatment (3‐month and 6‐month follow‐up), Outcome 3: BOP (change from baseline (%)); 3 months
1.4
1.4. Analysis
Comparison 1: Adjunctive aPDT versus control during active periodontal treatment (3‐month and 6‐month follow‐up), Outcome 4: BOP (change from baseline (%)); 6 months
1.5
1.5. Analysis
Comparison 1: Adjunctive aPDT versus control during active periodontal treatment (3‐month and 6‐month follow‐up), Outcome 5: CAL (change from baseline (mm)); 3 months
1.6
1.6. Analysis
Comparison 1: Adjunctive aPDT versus control during active periodontal treatment (3‐month and 6‐month follow‐up), Outcome 6: CAL (change from baseline (mm)); 6 months
1.7
1.7. Analysis
Comparison 1: Adjunctive aPDT versus control during active periodontal treatment (3‐month and 6‐month follow‐up), Outcome 7: REC (change from baseline (mm)); 3 months
1.8
1.8. Analysis
Comparison 1: Adjunctive aPDT versus control during active periodontal treatment (3‐month and 6‐month follow‐up), Outcome 8: REC (change from baseline (mm)); 6 months
1.9
1.9. Analysis
Comparison 1: Adjunctive aPDT versus control during active periodontal treatment (3‐month and 6‐month follow‐up), Outcome 9: PPD at 6 months. Subgroup analysis according to type of control (placebo or negative control)
1.10
1.10. Analysis
Comparison 1: Adjunctive aPDT versus control during active periodontal treatment (3‐month and 6‐month follow‐up), Outcome 10: CAL at 6 months. Subgroup analysis according to type of control (placebo or negative control)
2.1
2.1. Analysis
Comparison 2: Adjunctive aPDT versus control during supportive periodontal care (3‐month and 6‐month follow‐up), Outcome 1: PPD (change from baseline (mm)); 3 months
2.2
2.2. Analysis
Comparison 2: Adjunctive aPDT versus control during supportive periodontal care (3‐month and 6‐month follow‐up), Outcome 2: PPD (change from baseline (mm)); 6 months
2.3
2.3. Analysis
Comparison 2: Adjunctive aPDT versus control during supportive periodontal care (3‐month and 6‐month follow‐up), Outcome 3: BOP (change from baseline (%)); 3 months
2.4
2.4. Analysis
Comparison 2: Adjunctive aPDT versus control during supportive periodontal care (3‐month and 6‐month follow‐up), Outcome 4: BOP (change from baseline (%)); 6 months
2.5
2.5. Analysis
Comparison 2: Adjunctive aPDT versus control during supportive periodontal care (3‐month and 6‐month follow‐up), Outcome 5: CAL (change from baseline (mm)); 3 months
2.6
2.6. Analysis
Comparison 2: Adjunctive aPDT versus control during supportive periodontal care (3‐month and 6‐month follow‐up), Outcome 6: CAL (change from baseline (mm)); 6 months
2.7
2.7. Analysis
Comparison 2: Adjunctive aPDT versus control during supportive periodontal care (3‐month and 6‐month follow‐up), Outcome 7: REC (change from baseline (mm)); 3 months
2.8
2.8. Analysis
Comparison 2: Adjunctive aPDT versus control during supportive periodontal care (3‐month and 6‐month follow‐up), Outcome 8: REC (change from baseline (mm)); 6 months
3.1
3.1. Analysis
Comparison 3: Adjunctive aPDT versus SI alone during treatment of peri‐implant mucositis, Outcome 1: PPD (change from baseline(mm)); 3 months
3.2
3.2. Analysis
Comparison 3: Adjunctive aPDT versus SI alone during treatment of peri‐implant mucositis, Outcome 2: BOP (change from baseline (%)); 3 months
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References

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    1. Srikanth K, Chandra RV, Reddy AA, Reddy BH, Reddy C, Naveen A. Effect of a single session of antimicrobial photodynamic therapy using indocyanine green in the treatment of chronic periodontitis: a randomized controlled pilot trial. Quintessence International 2015;46:391-400. - PubMed
Talebi 2016 {published data only}
    1. Talebi M, Taliee R, Mojahedi M, Meymandi M, Torshabi M. Microbiological efficacy of photodynamic therapy as an adjunct to non-surgical periodontal treatment: a clinical trial. Journal of Lasers in Medical Sciences 2016;7:126-30. - PMC - PubMed
Theodoro 2012 {published data only}
    1. Theodoro LH, Silva SP, Pires JR, Soares GH, Pontes AE, Zuza EP, et al. Clinical and microbiological effects of photodynamic therapy associated with nonsurgical periodontal treatment. A 6-month follow-up. Lasers in Medical Science 2012;27:687-93. - PubMed

References to studies excluded from this review

Aabed 2022 {published data only}
    1. Aabed K, Moubayed N, BinShabaib MS, AlHarthi SS. Is a single session of antimicrobial photodynamic therapy as an adjuvant to non-surgical scaling and root planing effective in reducing periodontal inflammation and subgingival presence of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans in patients with periodontitis? Photodiagnosis and Photodynamic Therapy 2022;38:102847. - PubMed
Ahad 2016 {published data only}
    1. Ahad A, Lamba AK, Faraz F, Tandon S, Chawla K, Yadav N. Effect of antimicrobial photodynamic therapy as an adjunct to nonsurgical treatment of deep periodontal pockets: a clinical study. Journal of Lasers in Medical Sciences 2016;7:220-6. - PMC - PubMed
Ahmed 2023 {published data only}
    1. Ahmed AR, Kamran MA, Suleman G, Sharif RA, Alamrey AA, Sulaiman SA. Novel use of chloro-aluminum phthalocyanine assisted photodynamic therapy helps in periimplant healing among smoking patients. Photodiagnosis & Photodynamic Therapy 2023;41:103193. - PubMed
AlAhmari 2019 {published data only}
    1. AlAhmari F, Ahmed HB, Al-Kheraif AA, Javed F, Akram Z. Effectiveness of scaling and root planning with and without adjunct antimicrobial photodynamic therapy in the treatment of chronic periodontitis among cigarette-smokers and never-smokers: a randomized controlled clinical trial. Photodiagnosis and Photodynamic Therapy 2019;25:247–52. - PubMed
Al‐Askar 2022 {published data only}
    1. Al-Askar MH, Abdullatif FA, Alshihri AA, Ahmed A, Divakar DD, Almoharib H, et al. Comparison of photobiomodulation and photodynamic therapy as adjuncts to mechanical debridement for the treatment of peri-implantitis. Technology and Health Care 2022;30:389-98. - PubMed
Alasqah 2022 {published data only}
    1. Alasqah MN. Influence of adjunctive non-surgical peri‑implant therapy on clinical and salivary cytokine profile in obese patients. Photodiagnosis and Photodynamic Therapy 2022;37:102721. - PubMed
Al Deeb 2020 {published data only}
    1. Al Deeb M, Alresayes S, Mokeem SA, Alhenaki AM, AlHelal A, Shafqat SS, et al. Clinical and immunological peri-implant parameters among cigarette and electronic smoking patients treated with photochemotherapy: a randomized controlled clinical trial. Photodiagnosis and Photodynamic Therapy 2020;31:101800. - PubMed
Al‐Hamoudi 2022 {published data only}
    1. Al-Hamoudi N, Alali Y, Al-Aali K, Alhumaidan AA, Heer E, Tanveer SA, et al. Peri-implant parameters and bone metabolic markers among water-pipe users treated with photodynamic therapy. Photodiagnosis and Photodynamic Therapy 2022;37:102655. - PubMed
AlHarthi 2022 {published data only}
    1. AlHarthi SS, Alamry NZ, BinShabaib MS. Effect of multiple sessions of photodynamic therapy on bone regeneration around dental implants among patients with peri‑implantitis. Photodiagnosis and Photodynamic Therapy 2022;37:102612. - PubMed
Alqutub 2022 {published data only}
    1. Alqutub MN. Peri-implant parameters and cytokine profile among peri-implant disease patients treated with Er Cr YSGG laser and PDT. Photodiagnosis and Photodynamic Therapy 2022;37:102641. - PubMed
AlSarhan 2021 {published data only}
    1. AlSarhan MA, Altammami MA, Alaqeely RS, AlEbdi A, Jasser RA, Otaibi DA. Short-term improvement of clinical parameters and microbial diversity in periodontitis patients following indocyanine green-based antimicrobial photodynamic therapy: a randomized single-blind split-mouth cohort. Photodiagnosis and Photodynamic Therapy 2021;35:102349. - PubMed
Al‐Sowygh 2017 {published data only}
    1. Al-Sowygh ZH. Efficacy of periimplant mechanical curettage with and without adjunct antimicrobial photodynamic therapy in smokeless-tobacco product users. Photodiagnosis and Photodynamic Therapy 2017;18:260-3. - PubMed
Alvarenga 2019 {published data only}
    1. Alvarenga LH, Gomes AC, Carribeiro P, Godoy-Miranda B, Noschese G, Simões Ribeiro M, et al. Parameters for antimicrobial photodynamic therapy on periodontal pocket - randomized clinical trial. Photodiagnosis and Photodynamic Therapy 2019;27:132-6. - PubMed
Alzoman 2016 {published data only}
    1. Alzoman HA, Diab HM. Effect of gallium aluminium arsenide diode laser therapy on Porphyromonas gingivalis in chronic periodontitis: a randomized controlled trial. International Journal of Dental Hygiene 2016;14:261-6. - PubMed
Andersen 2007 {published data only}
    1. Andersen R, Loebel N, Hammond D, Wilson M. Treatment of periodontal disease by photodisinfection compared to scaling and root planing. Journal of Clinical Dentistry 2007;18:34-8. - PubMed
Annunziata 2023 {published data only}
    1. Annunziata M, Donnarumma G, Guida A, Nastri L, Persico G, Fusco A, et al. Clinical and microbiological efficacy of indocyanine green-based antimicrobial photodynamic therapy as an adjunct to non-surgical treatment of periodontitis: a randomized controlled clinical trial. Clinical Oral Investigations 2023;27(5):2385-94. - PMC - PubMed
Arsic 2022 {published data only}
    1. Arsic Z, Jovanovic R, Djordjevic A, Sehalic M, Marjanovic D, Mikic M et al. Clinical and microbiological effects of photodynamic therapy applied in non-surgical treatment of periodontitis. Vojnosanitetski Pregled 2022;79:17-24.
Balata 2013 {published data only}
    1. Balata ML, Andrade LP, Santos DB, Cavalcanti AN, Tunes Uda R, Ribeiro Edel P, et al. Photodynamic therapy associated with full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis: a randomized-controlled clinical trial. Journal of Applied Oral Science 2013;21:208-14. - PMC - PubMed
Bundidpun 2018 {published data only}
    1. Bundidpun P, Srisuwantha R, Laosrisin N. Clinical effects of photodynamic therapy as an adjunct to full-mouth ultrasonic scaling and root planing in treatment of chronic periodontitis. Laser Therapy 2018;27:33-9. - PMC - PubMed
Calderín 2013 {published data only}
    1. Calderín S, García-Núñez JA, Gómez C. Short-term clinical and osteoimmunological effects of scaling and root planing complemented by simple or repeated laser phototherapy in chronic periodontitis. Journal of Lasers in Medical Science 2013;28:157-66. - PubMed
Carvalho 2015 {published data only}
    1. Carvalho VF, Andrade PV, Rodrigues MF, Hirata MH, Hirata RD, Pannuti CM, et al. Antimicrobial photodynamic effect to treat residual pockets in periodontal patients: a randomized controlled clinical trial. Journal of Clinical Periodontology 2015;42:440–7. - PubMed
Correa 2016 {published data only}
    1. Correa MG, Oliveira DH, Saraceni CH, Ribeiro FV, Pimentel SP, Cirano FR, et al. Short-term microbiological effects of photodynamic therapy in non-surgical periodontal treatment of residual pockets: a split-mouth RCT. Lasers in Surgery and Medicine 2016;48:944-50. - PubMed
Costa 2023 {published data only}
    1. Costa FO, Esteves Lima RP, Costa AM, Costa AA, Mattos Pereira GH, Cortelli SC, et al. Adjunctive effects of photodynamic therapy using indocyanine green in residual pockets during periodontal maintenance therapy: a split-mouth randomized controlled trial. Journal of Periodontology 2023;94(9):1100-11. - PubMed
da Cruz Andrade 2017 {published data only}
    1. da Cruz Andrade PV, Euzebio Alves VT, Carvalho VF, Franco Rodrigues M, Pannuti CM, Holzhausen M, et al. Photodynamic therapy decrease immune-inflammatory mediators levels during periodontal maintenance. Journal of Lasers in Medical Science 2017;32:9-17. - PubMed
De Angelis 2012 {published data only}
    1. De Angelis N, Felice P, Grusovin MG, Camurati A, Esposito M. The effectiveness of adjunctive light-activated disinfection (LAD) in the treatment of peri-implantitis: 4-month results from a multicentre pragmatic randomised controlled trial. European Journal of Oral Implantology 2012;4:321-31. - PubMed
de Araujo Sena 2019 {published data only}
    1. Araújo Sena IA, Araújo Silva DN, da Silva Azevedo ML, da Silva NT, Longo JP, Moraes M, et al. Antimicrobial photodynamic therapy using a chloro-aluminum phthalocyanine adjuvant to nonsurgical periodontal treatment does not improve clinical parameters in patients with chronic periodontitis. Photobiomodulation, Photomedicine, and Laser Surgery 2019;37:729-35. - PubMed
De Freitas 2016 {published data only}
    1. De Freitas LM, Calixto GM, Chorilli M, Giusti JS, Bagnato VS, Soukos NS, et al. Polymeric nanoparticle-based photodynamic therapy for chronic periodontitis in vivo. International Journal of Molecular Sciences 2016;17:769. - PMC - PubMed
Esposito 2013 {published data only}
    1. Esposito M, Grusovin MG, De Angelis N, Camurati A, Campailla M, Felice P. The adjunctive use of light-activated disinfection (LAD) with FotoSan is ineffective in the treatment of peri-implantitis: 1-year results from a multicentre pragmatic randomised controlled trial. European Journal of Oral Implantology 2013;6:109-19. - PubMed
Fan 2022 {published data only}
    1. Fan YD, Shu R, Cheng L, Ge LH. Effectiveness of adjunctive photodynamic therapy in the treatment of stage III and IV periodontitis. Shanghai Journal of Stomatology 2022;31(5):501-6. - PubMed
Ge 2011 {published data only}
    1. Ge L, Shu R, Li Y, Li C, Luo L, Song Z, et al. Adjunctive effect of photodynamic therapy to scaling and root planing in the treatment of chronic periodontitis. Photomedicine and Laser Surgery 2011;29:33-7. - PubMed
Giannopoulou 2012 {published data only}
    1. Giannopoulou C, Cappuyns I, Cancela J, Cionca N, Mombelli A. Effect of photodynamic therapy, diode laser, and deep scaling on cytokine and acute-phase protein levels in gingival crevicular fluid of residual periodontal pockets. Journal of Periodontology 2012;83:1018-27. - PubMed
Goh 2017 {published data only}
    1. Goh EX, Tan KS, Chan YH, Lim LP. Effects of root debridement and adjunctive photodynamic therapy in residual pockets of patients on supportive periodontal therapy: a randomized split-mouth trial. Photodiagnosis and Photodynamic Therapy 2017;18:342-8. - PubMed
Javed 2016 {published data only}
    1. Javed F, Abduljabbar T, Carranza G, Gholamiazizi E, Mazgaj DK, Kellesarian SV, et al. Efficacy of periimplant mechanical debridement with and without adjunct antimicrobial photodynamic therapy in the treatment of periimplant diseases among cigarette smokers and non-smokers. Photodiagnosis and Photodynamic Therapy 2016;16:85-9. - PubMed
Javed 2017 {published data only}
    1. Javed F, BinShabaib MS, Alharthi SS, Qadri T. Role of mechanical curettage with and without adjunct antimicrobial photodynamic therapy in the treatment of peri-implant mucositis in cigarette smokers: a randomized controlled clinical trial. Photodiagnosis and Photodynamic Therapy 2017;18:331-4. - PubMed
Jung 2014 {published data only}
    1. Jung GU, Kim JW, Kim SJ, Pang EK. Effects of adjunctive daily phototherapy on chronic periodontitis: a randomized single-blind controlled trial. Journal of Periodontal & Implant Science 2014;44:280-7. - PMC - PubMed
Karimi 2016 {published data only}
    1. Karimi MR, Hasani A, Khosroshahian S. Efficacy of antimicrobial photodynamic therapy as an adjunctive to mechanical debridement in the treatment of peri-implant diseases: a randomized controlled clinical trial. Journal of Lasers in Medical Science 2016;7:139-45. - PMC - PubMed
Kashefi Mehr 2018 {published data only}
    1. Kashefi Mehr A, Pourabbas R, Khajeh MS. Effect of photodynamic therapy with toluidine blue photosensitizer on nonsurgical management of peri-implant mucosal inflammation. Annals of Tropical Medicine & Public Health 2018;2.2:SP45-18.
Kassa 2023 {published data only}
    1. Kassa CT, Salviatto LT, Tortamano AC, Rost-Lima KS, Damante CA, Pavani C, et al. Antimicrobial photodynamic therapy mediated by methylene blue in surfactant vehicle as adjuvant to periodontal treatment. Randomized, controlled, double-blind clinical trial. Photodiagnosis and Photodynamic Therapy 2023;41:(no pagination). - PubMed
Katsikanis 2020 {published data only}
    1. Katsikanis F, Strakas D, Vouros I. The application of antimicrobial photodynamic therapy (aPDT, 670 nm) and diode laser (940 nm) as adjunctive approach in the conventional cause-related treatment of chronic periodontal disease: a randomized controlled split-mouth clinical trial. Clinical Oral Investigations 2020;24:1821-7. - PubMed
Losev 2023 {published data only}
    1. Losev FF, Krechina EK, Ivanova EV, Kuksa EY, Guseva IE. The use of photodynamic therapy in the complex treatment of chronic generalized moderate periodontitis. Stomatologiia 2023;102(2):11-5. - PubMed
Luchesi 2013 {published data only}
    1. Luchesi VH, Pimentel SP, Kolbe MF, Ribeiro FV, Casarin RC, Nociti FH Jr, et al. Photodynamic therapy in the treatment of class II furcation: a randomized controlled clinical trial. Journal of Clinical Periodontology 2013;40:781-8. - PubMed
Lui 2011 {published data only}
    1. Lui J, Corbet EF, Jin L. Combined photodynamic and low-level laser therapies as an adjunct to nonsurgical treatment of chronic periodontitis. Journal of Periodontal Research 2011;46:89-96. - PubMed
Lulic 2009 {published data only}
    1. Lulic M, Leiggener Görög I, Salvi GE, Ramseier CA, Mattheos N, Lang NP. One-year outcomes of repeated adjunctive photodynamic therapy during periodontal maintenance: a proof-of-principle randomized-controlled clinical trial. Journal of Clinical Periodontology 2009;36:661-6. - PubMed
Mangalekar 2022 {published data only}
    1. Mangalekar SB, Hugar S, Golgire SM, Vhanmane P, Reader GM, Vijapure S, et al. A split-mouth longitudinal study comparing the efficacy of photodynamic therapy and ozone therapy in the treatment of chronic periodontitis without the use of surgical procedures. NeuroQuantology 2022;20(11):1089-97.
Mettraux 2011 {published data only}
    1. Mettraux G, Hüsler J. Der Einsatz der transgingivalen, antibakteriellen Fotodynamischen Therapie (PDT) zusätzlich zum Scaling und Root Planing [Der Einsatz der transgingivalen, antibakteriellen Fotodynamischen Therapie (PDT) zusätzlich zum Scaling und Root Planing]. Schweizer Monatsschrift für Zahnmedizin 2011;121:53-60. - PubMed
Müller Campanile 2015 {published data only}
    1. Müller Campanile VS, Giannopoulou C, Campanile G, Cancela JA, Mombelli A. Single or repeated antimicrobial photodynamic therapy as adjunct to ultrasonic debridement in residual periodontal pockets: clinical, microbiological, and local biological effects. Journal of Lasers in Medical Science 2015;30:27-34. - PMC - PubMed
Niazi 2020 {published data only}
    1. Niazi FH, Noushad M, Tanvir SB, Ali S, Al-Khalifa KS, Qamar Z, et al. Antimicrobial efficacy of indocyanine green-mediated photodynamic therapy compared with Salvadora persica gel application in the treatment of moderate and deep pockets in periodontitis. Photodiagnosis and Photodynamic Therapy 2020;29:101665. - PubMed
Petrović 2018 {published data only}
    1. Petrović MS, Kannosh IY, Milašin JM, Mihailović DS, Obradović RR, Bubanj SR, et al. Clinical, microbiological and cytomorphometric evaluation of low-level laser therapy as an adjunct to periodontal therapy in patients with chronic periodontitis. International Journal of Dental Hygiene 2018;16:e120-7. - PubMed
Pinheiro 2010 {published data only}
    1. Pinheiro SL, Donegá JM, Seabra LM, Adabo MD, Lopes T, do Carmo TH, et al. Capacity of photodynamic therapy for microbial reduction in periodontal pockets. Journal of Lasers in Medical Science 2010;25:87-91. - PubMed
Pourabbas 2023 {published data only}
    1. Pourabbas R, Khorramdel A, Sadighi M, Kashefimehr A, Mousavi S. Effect of photodynamic therapy as an adjunctive to mechanical debridement on the nonsurgical treatment of peri-implant mucositis: a randomized controlled clinical trial. Dental Research Journal 2023;20(1):1. - PMC - PubMed
Preshaw 2021 {published data only}
    1. Preshaw PM, Ide M, Bissett SM, Holliday R, Lansdowne N, Pickering K, et al. No benefit of an adjunctive phototherapy protocol in treatment of periodontitis: a split-mouth randomized controlled trial. Journal of Clinical Periodontology 2021;48:1093-102. - PubMed
Qamar 2021 {published data only}
    1. Qamar Z, Almohana SA, Khalid Alanazi A, Khalid Alanazi A, Almohana AA, Zeeshan T. Clinical evaluation of the effects of topical indocyanine-green mediated photosensitiser vs aloe vera gel as adjunct therapy to scaling and root planing in chronic periodontitis patients. Oral Health & Preventive Dentistry 2021;19:489-94. - PMC - PubMed
Raj 2016 {published data only}
    1. Raj KR, Musalaiah S, Nagasri M, Kumar PA, Reddy PI, Greeshma M. Evaluation of efficacy of photodynamic therapy as an adjunct to nonsurgical periodontal therapy in treatment of chronic periodontitis patients: a clinico-microbiological study. Indian Journal of Dental Research 2016;27:483-7. - PubMed
Segarra‐Vidal 2017 {published data only}
    1. Segarra-Vidal M, Guerra-Ojeda S, Vallés LS, López-Roldán A, Mauricio MD, Aldasoro M, et al. Effects of photodynamic therapy in periodontal treatment: a randomized, controlled clinical trial. Journal of Clinical Periodontology 2017;44:915-25. - PubMed
Shingnapurkar 2016 {published data only}
    1. Shingnapurkar SH, Mitra DK, Kadav MS, Shah RA, Rodrigues SV, Prithyani SS. The effect of indocyanine green-mediated photodynamic therapy as an adjunct to scaling and root planing in the treatment of chronic periodontitis: a comparative split-mouth randomized clinical trial. Indian Journal of Dental Research 2016;27:609-17. - PubMed
Sigusch 2010 {published data only}
    1. Sigusch BW, Engelbrecht M, Völpel A, Holletschke A, Pfister W, Schütze J. Full-mouth antimicrobial photodynamic therapy in Fusobacterium nucleatum-infected periodontitis patients. Journal of Periodontology 2010;81:975-81. - PubMed
Soundarajan 2022 {published data only}
    1. Soundarajan A, Rajasekar A. Comparative evaluation of combined efficacy of methylene blue mediated antimicrobial photodynamic therapy (a-PDT) using 660 nm diode laser versus Erbium-chromium-yttrium-scandium-gallium-garnet (Er, Cr: YSGG) laser as an adjunct to scaling and root planing on clinical parameters in supportive periodontal therapy: a randomized split-mouth trial. Photodiagnosis and Photodynamic Therapy 2022;39:102971. - PubMed
Sukumar 2020 {published data only}
    1. Sukumar K, Tadepalli A, Parthasarathy H, Ponnaiyan D. Evaluation of combined efficacy of photodynamic therapy using indocyanine green photosensitizer and non-surgical periodontal therapy on clinical and microbial parameters in the management of chronic periodontitis subjects: a randomized split-mouth design. Photodiagnosis and Photodynamic Therapy 2020;31:101949. - PubMed
Tabenski 2017 {published data only}
    1. Tabenski L, Moder D, Cieplik F, Schenke F, Hiller KA, Buchalla W, et al. Antimicrobial photodynamic therapy vs. local minocycline in addition to non-surgical therapy of deep periodontal pockets: a controlled randomized clinical trial. Clinical Oral Investigations 2017;21:2253-64. - PubMed
Wang 2019 {published data only}
    1. Wang H, Li W, Zhang D, Li W, Wang Z. Adjunctive photodynamic therapy improves the outcomes of peri-implantitis: a randomized controlled trial. Australian Dental Journal 2019;64:256-62. - PubMed
Wang 2022 {published data only}
    1. Wang H, Liu Y, Li W, Li W, Xu H, Niu G, et al. Microbiota in gingival crevicular fluid before and after mechanical debridement with antimicrobial photodynamic therapy in peri-implantitis. Frontiers in Cellular and Infection Microbiology 2022;11:777627. - PMC - PubMed
Yamashita 2022 {published data only}
    1. Yamashita Y, Mae M, Oohira M, Ozaki Y, Ohba S, Asahina I, et al. Clinical efficacy and safety of antimicrobial photodynamic therapy in residual periodontal pockets during the maintenance phase. Pharmaceuticals 2022;15(8):25. - PMC - PubMed

References to studies awaiting assessment

Al Deeb 2020c {published data only}
    1. Al Deeb M, Alsahhaf A, Mubaraki SA, Alhamoudi N, Al-Aalid KA, Abduljabbar T. Clinical and microbiological outcomes of photodynamic and systemic antimicrobial therapy in smokers with peri-implant inflammation. Photodiagnosis and Photodynamic Therapy 2020;29:101587. - PubMed
Alshibani 2022 {published data only}
    1. Alshibani N, Alssum L, Basudan A, Shaheen M, Alqutub MN, Dahash FA, et al. Non-surgical periodontal therapy with adjunct photodynamic therapy for the management of periodontal inflammation in adults using nicotine-free electronic-cigarette: a randomized controlled trial. Photodiagnosis and Photodynamic Therapy 2022;38:102820. - PubMed
Al‐Zawawi 2020 {published data only}
    1. Al-Zawawi AS, Bukhari IA, Bello-Correa FO, Sheikh SA, Albaijan R, Vohra F. Influence of root debridement with adjunct photodynamic therapy on periodontal parameters and gingival crevicular fluid cortisol levels among patients with and without type-2 diabetes mellitus. Photodiagnosis and Photodynamic Therapy 2020;32:102076. - PubMed
Elsadek 2023 {published data only}
    1. Elsadek MF, Almoajel A. Clinical and bacterial periodontal parameters with methylene blue-loaded nanoparticles incorporated in a natural plant-based vehicle for the treatment of Stage III Grade B periodontitis. Photodiagnosis and Photodynamic Therapy 2023;42:(no pagination).
Farhad 2015 {published data only}
    1. Farhad S, Aryam M, Mohammadi F, Birang E, Barekatain M, Zarei E. Effect of photodynamic therapy as adjunctive periodontal therapy on TNF-α level in gingival crevicular fluid. Journal of Research in Dental Sciences 2015;12(2):78-84.
Kharkar 2021 {published data only}
    1. Kharkar VV, Kolte AP, Kolte RA, Bawankar PV, Lathiya VN, Bodhare GH. Influence of adjunctive photodynamic therapy on interleukin-6, interleukin-8, and interleukin-10 gingival crevicular fluid levels in chronic periodontitis - a randomized controlled trial. Contemporary Clinical Dentistry 2021;12:235-40. - PMC - PubMed
Lopez 2020 {published data only}
    1. Lopez MA, Passarelli PC, Marra M, Lopez A, D'Angelo A, Moffa A, et al. Photodynamic therapy (PDT) in non-surgical treatment of periodontitis. Journal of Biological Regulators and Homeostatic Agents 2020;34:67-78. - PubMed
Mocanu 2021 {published data only}
    1. Mocanu RC, Martu MA, Luchian I, Sufaru IG, Maftei GA, Ioanid N, et al. Microbiologic profiles of patients with dental prosthetic treatment and periodontitis before and after photoactivation therapy - randomized clinical trial. Microorganisms 2021;9:713. - PMC - PubMed
Romeo 2016 {published data only}
    1. Romeo U, Nardi GM, Libotte F, Sabatini S, Palaia G, Grassi FR. The antimicrobial photodynamic therapy in the treatment of peri-implantitis. International Journal of Dentistry 2016;2016:7692387. - PMC - PubMed
Shetty 2022 {published data only}
    1. Shetty B, Ali D, Ahmed S, Ibraheem WI, Preethanath RS, Vellappally S, et al. Role of antimicrobial photodynamic therapy in reducing subgingival oral yeasts colonization in patients with peri-implant mucositis. Photodiagnosis and Photodynamic Therapy 2022;38:102803. - PubMed

References to ongoing studies

CTRI/2023/02/050002 {published data only}
    1. CTRI/2023/02/050002. Nanoparticle photodynamic therapy in periodontitis treatment [Comparative evaluation of clinical parameters and microbial load in periodontitis patients following indocyanine green doped with chitosan nanoparticles based antimicrobial photodynamic therapy and conventional scaling and root planing: a randomized split-mouth clinical trial]. trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2023/02/050002 (first received 22 February 2023).
CTRI/2023/04/051300 {published data only}
    1. CTRI/2023/04/051300. A clinical study to know the effect of photodynamic therapy using curcumin and methylene blue in chronic periodontitis patients [Comparative evaluation of photosensitizing effect of curcumin versus methylene blue in photodynamic therapy for the treatment of chronic periodontitis]. trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2023/04/051300 (first received 5 April 2023).

Additional references

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References to other published versions of this review

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