Indocyanine Green as a Photosensitizer in Periodontitis Treatment: A Systematic Review of Randomized Controlled Trials

Abstract

Photodynamic therapy (PDT) using indocyanine green (ICG) has gained attention as an adjunctive treatment for periodontitis due to its antimicrobial and anti-inflammatory properties and its ability to penetrate deep periodontal tissues via near-infrared light activation. We aimed to evaluate the clinical and microbiological efficacy of ICG-mediated PDT as an adjunct to conventional periodontal therapy in patients with periodontitis based on data from randomized controlled trials (RCTs). A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted to identify randomized controlled trials (RCTs) exclusively investigating ICG-PDT in periodontitis based on predefined eligibility criteria. Studies were selected based on predefined inclusion criteria, and methodological quality was assessed using a 14-point scoring system. Data were extracted on clinical outcomes (e.g., probing depth, clinical attachment level) and microbiological changes. Sixteen RCTs met the inclusion criteria. Most studies reported improvements in probing depth, clinical attachment level, and microbial reduction following ICG-aPDT; however, some trials found no significant differences compared to control groups. These discrepancies may be attributable to variations in laser settings, ICG concentration, treatment frequency, or initial disease severity. Microbiological benefits included significant reductions in key periodontal pathogens. The therapy was well tolerated, with no adverse effects reported. However, variability in treatment protocols and limited long-term follow-up restricted the ability to draw definitive conclusions. ICG-mediated PDT is a promising, safe, and effective adjunct in periodontal therapy. Future trials should aim for protocol standardization and long-term outcome assessment to strengthen clinical guidance.

Keywords: adjunctive periodontal treatment; antimicrobial therapy; clinical attachment level; diode laser; indocyanine green; periodontitis; photodynamic therapy; probing depth.

Figure 1

PRISMA 2020 flow diagram.