Lasers in Medical Science

, Volume 33, Issue 2, pp 407–423 | Cite as

Efficacy of photodynamic therapy as adjunct treatment of chronic periodontitis: a systematic review and meta-analysis

  • Adriano Azaripour
  • Sebastian Dittrich
  • Cornelis J. F. Van Noorden
  • Brita Willershausen
Review Article
First Online:
Received:
Accepted:
  • 229 Downloads

Abstract

Meta-analysis of treatment effects of antimicrobial photodynamic therapy (aPDT) adjunct to non-surgical scaling and root planing (SRP) in comparison to SRP alone on patients with chronic periodontitis. The meta-analysis was performed according to PRISMA statement and Cochrane Collaboration guidelines. Electronic search complemented by hand search assured a high yield of randomized controlled trials (RCTs) of aPDT as adjunct modality to SRP. Differences in probing depth (PD) and clinical attachment level (CAL) were calculated with 95% confidence intervals and pooled in a random effects model. Analysis for intra- and inter-study heterogeneity was provided by χ 2 and I 2 tests, and publication bias was checked by funnel plots. Pooled overall effects of 26 RCTs attested significant benefits of aPDT adjunct to SRP with respect to PD reduction (MD 0.37; 95% CI 0.12–0.53; P < 0.0001) and CAL gain (MD 0.33; 95% CI 0.19–0.48; P < 0.00001) after 3 and 6 months. Sensitivity analysis minimized heterogeneity of PD reduction (MD 0.21; 95% CI 0.13–0.30; P < 0.00001) and CAL gain (MD 0.36; 95% CI 0.27–0.46). aPDT adjunct to SRP provides significant PD reduction and CAL gain in treatment of chronic periodontitis. This moderate effect was found after 3 and 6 months which is short from a clinical perspective.

Keywords

Photodynamic therapy Meta-analysis Chronic periodontitis Scaling and root planing 
This is a preview of subscription content, log in to check access.

Notes

Funding information

No funding from sources other than the Department of Operative Dentistry and Periodontology of the University Medical Center Mainz has to be reported.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

10103_2017_2383_MOESM1_ESM.jpg (2.3 mb)
Appendix Fig. 1 Forest plot of PD reduction and CAL gain after 3 month (JPEG 2366 kb)
10103_2017_2383_MOESM2_ESM.jpg (1.8 mb)
Appendix Fig. 2 Forest plot of PD reduction and CAL gain after 6 month (JPEG 1857 kb)
10103_2017_2383_MOESM3_ESM.jpg (1.8 mb)
Appendix Fig. 3 Forest plot of PD reduction and CAL gain after 12 month (JPEG 1817 kb)
10103_2017_2383_MOESM4_ESM.jpg (2.3 mb)
Appendix Fig. 4 Forest plot of PD reduction and CAL gain after various incubation periods with photosensitizer (JPEG 2356 kb)
10103_2017_2383_MOESM5_ESM.jpg (2.3 mb)
Appendix Fig. 5 Forest plot of PD reduction and CAL gain after various periods of activation time of photosensitizer (JPEG 2377 kb)
10103_2017_2383_MOESM6_ESM.jpg (1.9 mb)
Appendix Fig. 6 Forest plot of PD reduction and CAL gain in studies with low bias risk (JPEG 1932 kb)
10103_2017_2383_MOESM7_ESM.jpg (2.1 mb)
Appendix Fig. 7 Forest plot of PD reduction and CAL gain in studies with high bias risk (JPEG 2187 kb)
10103_2017_2383_MOESM8_ESM.jpg (1.4 mb)
Appendix Fig. 8 Funnel plot of overall PD reduction (JPEG 1415 kb)
10103_2017_2383_MOESM9_ESM.docx (16 kb)
Appendix 1 Search strategy (DOCX 15 kb)
10103_2017_2383_MOESM10_ESM.jpg (2.1 mb)
Appendix 2 Flow diagram according to the PRISMA Statement (JPEG 2187 kb)
10103_2017_2383_MOESM11_ESM.docx (44 kb)
Appendix 3 Modified quality assessment according to the Cochrane Handbook for Systematic Reviews of Interventions (DOCX 43 kb)
10103_2017_2383_MOESM12_ESM.docx (58 kb)
Appendix 4 Excluded studies from systematic review with reasons for exclusion (DOCX 57 kb)
10103_2017_2383_MOESM13_ESM.docx (21 kb)
ESM 1 Appendix list of references (DOCX 20 kb)

References

  1. 1.
    Aas JA, Paster BJ, Stokes LN, Olsen I, Dewhirst FE (2005) Defining the normal bacterial flora of the oral cavity. J Clin Microbiol 43(11):5721–5732CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Beikler T, Flemmig TF (2011) Oral biofilm-associated diseases: trends and implications for quality of life, systemic health and expenditures. Periodontol 55(1):87–103CrossRefGoogle Scholar
  3. 3.
    Marsh PD, Moter A, Devine DA (2011) Dental plaque biofilms: communities, conflict and control. Periodontol 55(1):16–35CrossRefGoogle Scholar
  4. 4.
    Berezow AB, Darveau RP (2011) Microbial shift and periodontitis. Periodontol 55(1):36–47CrossRefGoogle Scholar
  5. 5.
    Page RC, Offenbacher S, Schroeder HE, Seymour GJ, Kornman KS (1997) Advances in the pathogenesis of periodontitis: summary of developments, clinical implications and future directions. Periodontol 14:216–248CrossRefGoogle Scholar
  6. 6.
    Heitz-Mayfield LJA, Lang NP (2013) Surgical and nonsurgical periodontal therapy. Learned and unlearned concepts. Periodontol 62:218–231CrossRefGoogle Scholar
  7. 7.
    Hung HC, Douglass CW (2002) Meta-analysis of the effect of scaling and root planing, surgical treatment and antibiotic therapies on periodontal probing depth and attachment loss. J Clin Periodontol 29(11):975–986CrossRefPubMedGoogle Scholar
  8. 8.
    Flemmig TF, Beikler T. (2011) Control of oral biofilms. Periodontology 2000. 55(1):9–15.Google Scholar
  9. 9.
    How KY, Song KP, Chan KG (2016) Porphyromonas gingivalis: an overview of periodontopathic pathogen below the gum line. Front Microbiol 7:53CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ardila CM, Lopez MA, Guzman IC (2010) High resistance against clindamycin, metronidazole and amoxicillin in Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans isolates of periodontal disease. Med Oral Patol Oral Cir Bucal 15(6):E947–EE51CrossRefPubMedGoogle Scholar
  11. 11.
    van Winkelhoff AJ, Winkel EG (2009) Antibiotics in periodontics: right or wrong? J Periodontol 80(10):1555–1558CrossRefPubMedGoogle Scholar
  12. 12.
    Meyer-Betz F. (1913) Untersuchung über die biologische (photodynamische) Wirkung des Hämatoporphyrins und anderer Derivate des Blut-und Gallenfarbstoffes. Dtsch Arch Klin Med 112:476–503Google Scholar
  13. 13.
    Jori G, Fabris C, Soncin M, Ferro S, Coppellotti O, Dei D et al (2006) Photodynamic therapy in the treatment of microbial infections: basic principles and perspective applications. Lasers Surg Med 38(5):468–481CrossRefPubMedGoogle Scholar
  14. 14.
    Wainwright M, Crossley KB (2004) Photosensitising agents—circumventing resistance and breaking down biofilms: a review. Int Biodeterior Biodegrad 53(2):119–126CrossRefGoogle Scholar
  15. 15.
    Atieh MA (2010) Photodynamic therapy as an adjunctive treatment for chronic periodontitis: a meta-analysis. Lasers Med Sci 25(4):605–613CrossRefPubMedGoogle Scholar
  16. 16.
    Azarpazhooh A, Shah PS, Tenenbaum HC, Goldberg MB (2009) The effect of photodynamic therapy for periodontitis: a systematic review and meta-analysis. J Periodontol 81(1):4–14CrossRefGoogle Scholar
  17. 17.
    Sgolastra F, Petrucci A, Gatto R, Marzo G, Monaco A (2013) Photodynamic therapy in the treatment of chronic periodontitis: a systematic review and meta-analysis. Lasers Med Sci 28(2):669–682CrossRefPubMedGoogle Scholar
  18. 18.
    Sgolastra F, Petrucci A, Severino M, Graziani F, Gatto R, Monaco A (2013) Adjunctive photodynamic therapy to non-surgical treatment of chronic periodontitis: a systematic review and meta-analysis. J Clin Periodontol 40(5):514–526CrossRefPubMedGoogle Scholar
  19. 19.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ (Clinical research ed) 339:b2700CrossRefGoogle Scholar
  20. 20.
    Forrest JL, Miller SA. (2001) Enhancing your practice through evidence-based decision making: finding the best clinical evidence. J Evid Based Dent Pract 1(3):227–36Google Scholar
  21. 21.
    Armitage GC (1999) Development of a classification system for periodontal diseases and conditions. Ann Periodontol / Am Acad Periodontol 4(1):1–6CrossRefGoogle Scholar
  22. 22.
    Landis JR, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 33(2):363–374CrossRefPubMedGoogle Scholar
  23. 23.
    Higgins JPT, Green S (2011). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from http://handbook.cochrane.org
  24. 24.
    Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D et al (2001) The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 134(8):663–694CrossRefPubMedGoogle Scholar
  25. 25.
    Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Lesaffre E, Philstrom B, Needleman I, Worthington H (2009) The design and analysis of split-mouth studies: what statisticians and clinicians should know. Stat Med 28(28):3470–3482CrossRefPubMedGoogle Scholar
  27. 27.
    Follmann D, Elliott P, Suh I, Cutler J (1992) Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol 45(7):769–773CrossRefPubMedGoogle Scholar
  28. 28.
    Lau J, Ioannidis JP, Schmid CH (1997) Quantitative synthesis in systematic reviews. Ann Intern Med 127(9):820–826CrossRefPubMedGoogle Scholar
  29. 29.
    Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ (Clinical research ed) 327(7414):557–560CrossRefGoogle Scholar
  30. 30.
    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558CrossRefPubMedGoogle Scholar
  31. 31.
    Sterne JA, Egger M (2001) Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 54(10):1046–1055CrossRefPubMedGoogle Scholar
  32. 32.
    Al-Zahrani MS, Austah ON (2011) Photodynamic therapy as an adjunctive to scaling and root planing in treatment of chronic periodontitis in smokers. Saudi Medical Journal [Internet] 11:1183–1188Google Scholar
  33. 33.
    Alwaeli HA, Al-Khateeb SN, Al-Sadi A. (2015) Long-term clinical effect of adjunctive antimicrobial photodynamic therapy in periodontal treatment: a randomized clinical trial. Lasers Med Sci. 30(2):801–7Google Scholar
  34. 34.
    Andersen R, Loebel N, Hammond D, Wilson M (2007) Treatment of periodontal disease by photodisinfection compared to scaling and root planing. J Clin Dent [Internet] 2:34–38Google Scholar
  35. 35.
    Balata ML, de Andrade LP, Santos DB, Cavalcanti AN, Tunes Uda R, Ribeiro Edel P et al (2013) Photodynamic therapy associated with full-mouth ultrasonic debridement in the treatment of severe chronic periodontitis: a randomized-controlled clinical trial. J Appl Oral Sci Revista FOB 21(2):208–214CrossRefPubMedGoogle Scholar
  36. 36.
    Bassir SH, Moslemi N, Jamali R, Mashmouly S, Fekrazad R, Chiniforush N et al (2013) Photoactivated disinfection using light-emitting diode as an adjunct in the management of chronic periodontitis: a pilot double-blind split-mouth randomized clinical trial. J Clin Periodontol 40(1):65–72CrossRefPubMedGoogle Scholar
  37. 37.
    Berakdar M, Callaway A, Fakhr Eddin M, Ross A, Willershausen B (2012) Comparison between scaling-root-planing (SRP) and SRP/photodynamic therapy: six-month study. Head Face Med 8:12CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Betsy J, Prasanth CS, Baiju KV, Prasanthila J, Subhash N (2014) Efficacy of antimicrobial photodynamic therapy in the management of chronic periodontitis: a randomized controlled clinical trial. J Clin Periodontol 41(6):573–581CrossRefPubMedGoogle Scholar
  39. 39.
    Birang R, Shahaboui M, Kiani S, Shadmehr E, Naghsh N (2015) Effect of Nonsurgical Periodontal Treatment Combined With Diode Laser or Photodynamic Therapy on Chronic Periodontitis: A Randomized Controlled Split-Mouth Clinical Trial. Journal of lasers in medical sciences 6(3):112–119CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Braun A, Dehn C, Krause F, Jepsen S (2008) Short-term clinical effects of adjunctive antimicrobial photodynamic therapy in periodontal treatment: a randomized clinical trial. Journal of Clinical Periodontology 35(10):877–884Google Scholar
  41. 41.
    Campos G, Pimentel S, Ribeiro F, Casarin RV, Cirano F, Saraceni CC et al (2013) The adjunctive effect of photodynamic therapy for residual pockets in single-rooted teeth: a randomized controlled clinical trial. Lasers Med Sci 28(1):317–324CrossRefPubMedGoogle Scholar
  42. 42.
    Cappuyns I, Cionca N, Wick P, Giannopoulou C, Mombelli A (2012) Treatment of residual pockets with photodynamic therapy, diode laser, or deep scaling. A randomized, split-mouth controlled clinical trial. Lasers in Medical Science 27(5):979–986CrossRefPubMedGoogle Scholar
  43. 43.
    Chondros P, Nikolidakis D, Christodoulides N, Rössler R, Gutknecht N, Sculean A (2009) Photodynamic therapy as adjunct to non-surgical periodontal treatment in patients on periodontal maintenance: a randomized controlled clinical trial. Lasers in Medical Science 24(5):681–688CrossRefPubMedGoogle Scholar
  44. 44.
    Christodoulides N, Nikolidakis D, Chondros P, Becker J, Schwarz F, Rössler R, Sculean A (2008) Photodynamic Therapy as an Adjunct to Non-Surgical Periodontal Treatment: A Randomized, Controlled Clinical Trial. Journal of Periodontology 79(9):1638–1644CrossRefPubMedGoogle Scholar
  45. 45.
    Correa MG, Oliveira DH, Saraceni CH, Ribeiro FV, Pimentel SP, Cirano FR, et al (2015) Short-term microbiological effects of photodynamic therapy in non-surgical periodontal treatment of residual pockets: a split-mouth RCT. Lasers Surg Med 48(10):944–950Google Scholar
  46. 46.
    Dilsiz A, Canakci V, Aydin T (2013) Clinical effects of potassium-titanyl-phosphate laser and photodynamic therapy on outcomes of treatment of chronic periodontitis: a randomized controlled clinical trial. J Periodontol. 84(3):278–286Google Scholar
  47. 47.
    Franco EJ, Pogue RE, Sakamoto LHT, Cavalcante LLM, Carvalho DR, de Andrade RV (2014) Increased expression of genes after periodontal treatment with photodynamic therapy. Photodiagn Photodyn Ther 11(1):41–47CrossRefGoogle Scholar
  48. 48.
    Ge L, Shu R, Li Y, Li C, Luo L, Song Z et al (2010) Adjunctive effect of photodynamic therapy to scaling and root Planing in the treatment of chronic periodontitis. Photomed Laser Surg 29(1):33–37CrossRefPubMedGoogle Scholar
  49. 49.
    Lulic M, Gorog IL, Salvi GE, Ramseier CA, Mattheos N, Lang NP (2009) One-year outcomes of repeated adjunctive photodynamic therapy during periodontal maintenance: a proof-of-principle randomized-controlled clinical trial. J Clin Periodontol. 36(8):661–666CrossRefPubMedGoogle Scholar
  50. 50.
    Monzavi A, Chinipardaz Z, Mousavi M, Fekrazad R, Moslemi N, Azaripour A et al (2016) Antimicrobial photodynamic therapy using diode laser activated indocyanine green as an adjunct in the treatment of chronic periodontitis: a randomized clinical trial. Photodiagn Photodyn Ther 14:93–97CrossRefGoogle Scholar
  51. 51.
    Muller Campanile VS, Giannopoulou C, Campanile G, Cancela JA, Mombelli A (2013) Single or repeated antimicrobial photodynamic therapy as adjunct to ultrasonic debridement in residual periodontal pockets: clinical, microbiological, and local biological effects. Lasers Med Sci 30(1):27–34Google Scholar
  52. 52.
    Petelin M, Perkič K, Seme K, Gašpirc B (2014) Effect of repeated adjunctive antimicrobial photodynamic therapy on subgingival periodontal pathogens in the treatment of chronic periodontitis. Lasers Med Sci 30(6):1647–56Google Scholar
  53. 53.
    Polansky R, Haas M, Heschl A, Wimmer G (2009) Clinical effectiveness of photodynamic therapy in the treatment of periodontitis. Journal of Clinical Periodontology 36(7):575–580Google Scholar
  54. 54.
    Pourabbas R, Kashefimehr A, Rahmanpour N, Babaloo Z, Kishen A, Tenenbaum HC, Azarpazhooh A (2014) Effects of Photodynamic Therapy on Clinical and Gingival Crevicular Fluid Inflammatory Biomarkers in Chronic Periodontitis: A Split-Mouth Randomized Clinical Trial. Journal of Periodontology 85(9):1222–1229Google Scholar
  55. 55.
    Pulikkotil SJ, Toh CG, Mohandas K, Leong KV (2016) Effect of photodynamic therapy on Aggregatibacter actinomycetemcomitans in periodontitis patients. A randomized split mouth clinical trial. Aust Dent J 61(4):440–445Google Scholar
  56. 56.
    Queiroz AC, Suaid FA, de Andrade PF, Oliveira FS, Novaes AB, Taba M, Palioto DB, Grisi MFM, Souza SLS (2015) Adjunctive effect of antimicrobial photodynamic therapy to nonsurgical periodontal treatment in smokers: a randomized clinical trial. Lasers in Medical Science 30(2):617–625Google Scholar
  57. 57.
    Srikanth K, Chandra RV, Reddy AA, Reddy BH, Reddy C, Naveen A (2015) 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 46(5):391–400Google Scholar
  58. 58.
    Sreedhar A, Sarkar I, Rajan P, Pai J, Malagi S, Kamath V et al (2015) Comparative evaluation of the efficacy of curcumin gel with and without photo activation as an adjunct to scaling and root planing in the treatment of chronic periodontitis: a split mouth clinical and microbiological study. J Nat Sci Biol Med 6(Suppl 1):S102–S109CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Sigusch BW, Engelbrecht M, Volpel A, Holletschke A, Pfister W, Schutze J (2010) Full-mouth antimicrobial photodynamic therapy in Fusobacterium nucleatum-infected periodontitis patients. J Periodontol 81(7):975–981CrossRefPubMedGoogle Scholar
  60. 60.
    Theodoro LH, Silva SP, Pires JR, Soares GHG, Pontes AEF, Zuza EP et al (2012) Clinical and microbiological effects of photodynamic therapy associated with nonsurgical periodontal treatment. A 6-month follow-up. Lasers Med Sci 27(4):687–693CrossRefPubMedGoogle Scholar
  61. 61.
    Kranz S, Huebsch M, Guellmar A, Voelpel A, Tonndorf-Martini S, Sigusch BW (2015) Antibacterial photodynamic treatment of periodontopathogenic bacteria with indocyanine green and near-infrared laser light enhanced by Trolox(TM). Lasers Surg Med 47(4):350–360CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2017

Authors and Affiliations

  • Adriano Azaripour
    • 1
  • Sebastian Dittrich
    • 1
  • Cornelis J. F. Van Noorden
    • 2
  • Brita Willershausen
    • 1
  1. 1.Department of Operative Dentistry and PeriodontologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
  2. 2.Department of Cell Biology and Histology, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands

Personalised recommendations