Skip to main content

Advertisement

SpringerLink
Log in

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

  • Review Article
  • Published:
Lasers in Medical Science Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Flemmig TF (1999) Periodontitis. Ann Periodontol 4:32–37

    Article  CAS  PubMed  Google Scholar 

  2. Dzink JL, Tanner AC, Haffajee AD, Socransky SS (1985) Gram negative species associated with active destructive periodontal lesions. J Clin Periodontol 12:648–659

    Article  CAS  PubMed  Google Scholar 

  3. Takeuchi Y, Umeda M, Ishizuka M, Huang Y, Ishikawa I (2003) Prevalence of periodontopathic bacteria in aggressive periodontitis patients in a Japanese population. J Periodontol 74:1460–1469

    Article  PubMed  Google Scholar 

  4. Haffajee AD, Socransky SS (1994) Microbial etiological agents of destructive periodontal diseases. Periodontol 2000 5:78–111

    Article  CAS  PubMed  Google Scholar 

  5. Darveau RP, Tanner A, Page RC (1997) The microbial challenge in periodontitis. Periodontol 2000 14:12–32

    Article  CAS  PubMed  Google Scholar 

  6. Drisko CH (1996) Non-surgical pocket therapy: pharmacotherapeutics. Ann Periodontol 1:491–566

    CAS  PubMed  Google Scholar 

  7. Tonetti MS, et Lindhe J (1997) The use of topical antibiotics in periodontal pockets. In: Lang NP, Karring T (eds) Proceedings of the 2nd European Workshop on Periodontology. Quintessence, Berlin, pp 78–109

    Google Scholar 

  8. Walker CB (1996) The acquisition of antibiotic resistance in the periodontal microflora. Periodontol 2000 10:79–88

    Article  CAS  PubMed  Google Scholar 

  9. Feres M, Haffajee AD, Allard K, Som S, Goodson JM, Socransky SS (2002) Antibiotic resistance of subgingival species during and after antibiotic therapy. J Clin Periodontol 29:724–735

    Article  CAS  PubMed  Google Scholar 

  10. Raab O (1900) The effect of fluorescent agents on infusoria (in German). Z Biol 39:524–526

    CAS  Google Scholar 

  11. Wilson M (1993) Photolysis of oral bacteria and its potential use in the treatment of caries and periodontal disease. J Appl Bacteriol 75:299–306

    CAS  PubMed  Google Scholar 

  12. Hamblin MR, Hasan T (2004) Photodynamic therapy: a new antimicrobial approach to infectious disease? Photochem Photobiol Sci 3:436–450

    Article  CAS  PubMed  Google Scholar 

  13. Konopka K, Goslinski T (2007) Photodynamic therapy in dentistry. J Dent Res 86:694–707

    Article  CAS  PubMed  Google Scholar 

  14. Dougherty TJ, Marcus SL (1992) Photodynamic therapy. Eur J Cancer 28:1734–1742

    Article  Google Scholar 

  15. Takasaki AA, Aoki A, Mizutani K, Schwarz F, Sculean A, Wang CY, Koshy G, Romanos G, Ishikawa I, Izumi Y (2009) Application of antimicrobial photodynamic therapy in periodontal and peri-implant diseases. Periodontol 2000 51:109–140

    Article  PubMed  Google Scholar 

  16. Dörtbudak O, Haas R, Bernhart T, Mailath-Pokorny G (2001) Lethal photosensitization for decontamination of implant surfaces in the treatment of peri-implantitis. Clin Oral Implants Res 12:104–108

    Article  PubMed  Google Scholar 

  17. Haas R, Baron M, Dörtbudak O, Watzek G (2000) Lethal photosensitization, autogenous bone, and e-PTFE membrane for the treatment of peri-implantitis: preliminary results. Int J Oral Maxillofac Implants 15:374–382

    CAS  PubMed  Google Scholar 

  18. Garcez AS, Ribeiro MS, Tegos GP, Núñez SC, Jorge AO, Hamblin MR (2007) Antimicrobial photodynamic therapy combined with conventional endodontic treatment to eliminate root canal biofilm infection. Lasers Surg Med 39:59–66

    Article  PubMed  Google Scholar 

  19. Bertoloni G, Rossi F, Valduga G, Jori G, Ali H, van Lier JE (1992) Photosensitizing activity of water- and lipid-soluble phthalocyanines on prokaryotic and eukaryotic microbial cells. Microbios 71:33–46

    CAS  PubMed  Google Scholar 

  20. Bertoloni G, Salvato B, Dall’Acqua M, Vazzoler M, Jori G (1984) Hematoporphyrin-sensitized photoinactivation of Streptococcus faecalis. Photochem Photobiol 39:811–816

    Article  CAS  PubMed  Google Scholar 

  21. Nitzan Y, Shainberg B, Malik Z (1987) The photodynamic effects of deuteroporphyrin on gram-positive bacteria. Curr Microbiol 15:251–258

    Article  CAS  Google Scholar 

  22. Nitzan Y, Gutterman M, Malik Z, Ehrenberg B (1992) Inactivation of gram-negative bacteria by photosensitized porphyrins. Photochem Photobiol 55:89–96

    Article  CAS  PubMed  Google Scholar 

  23. Pfitzner A, Sigusch BW, Albrecht V, Glockmann E (2004) Killing of periodontopathogenic bacteria by photodynamic therapy. J Periodontol 75:1343–1349

    Article  CAS  PubMed  Google Scholar 

  24. Soukos NS, Ximenez-Fyvie LA, Hamblin MR, Socransky SS, Hasan T (1998) Targeted antimicrobial photochemotherapy. Antimicrob Agents Chemother 42:2595–2601

    CAS  PubMed  Google Scholar 

  25. Sarkar S, Wilson M (1993) Lethal photosensitization of bacteria in subgingival plaque from patients with chronic periodontitis. J Periodontal Res 28:204–210

    Article  CAS  PubMed  Google Scholar 

  26. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (1999) Improving the quality of reports of meta-analyses of randomized controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet 354:1896–1900

    Article  CAS  PubMed  Google Scholar 

  27. Miller SA, Forrest JL (2001) Enhancing your practice through evidence-based decision making: PICO, learning how to ask good questions. J Evid Base Dent Pract 1:136–141

    Article  Google Scholar 

  28. Armitage GC (1999) Development of a classification system for periodontal diseases and conditions. Ann Periodontol 4:1–6

    Article  CAS  PubMed  Google Scholar 

  29. Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  CAS  PubMed  Google Scholar 

  30. Higgins JPT, Green S (eds) (2006) Assessment of study quality. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 [updated September 2006]; Section 4. In: The Cochrane Library, Issue 4. Chichester, UK: John Wiley & Sons

  31. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of the sample. BMC Med Res Methodol 5:13

    Article  PubMed  Google Scholar 

  32. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    Article  CAS  PubMed  Google Scholar 

  33. Lau J, Ioannidis JP, Schmid CH (1997) Quantitative synthesis in systematic reviews. Ann Intern Med 127:820–826

    CAS  PubMed  Google Scholar 

  34. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558

    Article  PubMed  Google Scholar 

  35. qqSterne JA, Egger M (2001) Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 54:1046–1055

    Article  CAS  PubMed  Google Scholar 

  36. Karpinia K, Magnusson I, Gibbs C, Yank MCK (2004) Accuracy of probing attachment levels using a CEJ probe versus traditional probes. J Clin Periodontol 31:173–176

    Article  CAS  PubMed  Google Scholar 

  37. Neill ME, Mellonig JT (1997) Clinical efficacy of the Nd:YAG laser for combination periodontitis therapy. Pract Periodontics Aesthet Dent 9(Suppl 6):1–5

    CAS  PubMed  Google Scholar 

  38. Kelbauskiene S, Maciulskiene V (2007) A pilot study of Er,Cr:YSGG laser therapy used as an adjunct to scaling and root planing in patients with early and moderate periodontitis. Stomatologija 9:21–26

    PubMed  Google Scholar 

  39. Crespi R, Cappare P, Toscanelli I, Gherlone E, Romanos GE (2007) Effects of Er:YAG laser compared to ultrasonic scaler in periodontal treatment: a 2-year follow-up split-mouth clinical study. J Periodontol 78:1195–1200

    Article  PubMed  Google Scholar 

  40. Ambrosini P, Miller N, Briancon S, Gallina S, Penaud J (2005) Clinical and microbiological evaluation of the effectiveness of the Nd:Yap laser for initial treatment of adult periodontitis. A randomized controlled study. J Clin Periodontol 32:670–676

    Article  PubMed  Google Scholar 

  41. Ge LH, Shu R, Shen MH (2008) Effect of photodynamic therapy on IL-1beta and MMP-8 in gingival crevicular fluid of chronic periodontitis. Shanghai Kou Qiang Yi Xue 17:10–14

    PubMed  Google Scholar 

  42. Lin Z, Wang Y, Zhang X et al (2007) Clinical efficacy of a new photodynamic treatment for periodontal diseases. J Dent Res 86(Spec Iss A):1196

    Google Scholar 

  43. Zhu X, Lin Z, Wang Y et al (2007) Recovery rates of periodontal pockets treated with photodynamic disinfection. J Dent Res 86(Spec Iss A):1199

    Google Scholar 

  44. de Oliveira RR, Schwartz-Filho HO, Novaes AB Jr, Taba M Jr (2007) Antimicrobial photodynamic therapy in the non-surgical treatment of aggressive periodontitis: a preliminary randomized controlled clinical study. J Periodontol 78:965–973

    Article  PubMed  Google Scholar 

  45. Yilmaz S, Kuru B, Kuru L, Noyan Ü, Argun D, Kadir T (2002) Effect of gallium arsenide diode laser on human periodontal disease: a microbiological and clinical study. Lasers Surg Med 30:60–66

    Article  PubMed  Google Scholar 

  46. Andersen R, Loebel N, Hammond D, Wilson M (2007) Treatment of periodontal disease by photodisinfection compared to scaling and root planing. J Clin Dent 18:34–38

    PubMed  Google Scholar 

  47. 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. J Clin Periodontol 35:877–884

    Article  CAS  PubMed  Google Scholar 

  48. Chondros P, Nikolidakis D, Christodoulides N, Rössler R, Gutknecht N, Sculean A (2008) Photodynamic therapy as adjunct to non-surgical periodontal treatment in patients on periodontal maintenance: a randomized controlled clinical trial. Lasers Med Sci 24:681–688

    Article  PubMed  Google Scholar 

  49. Christodoulides N, Nikolidakis D, Chondros P et al (2008) Photodynamic therapy as an adjunct to non-surgical periodontal treatment: a randomized controlled clinical trial. J Periodontol 79:1638–1644

    Article  PubMed  Google Scholar 

  50. Cortelli JR, Querido SM, Aquino DR, Ricardo LH, Pallos D (2006) Longitudinal clinical evaluation of adjunct minocycline in the treatment of chronic periodontitis. J Periodontol 77:161–166

    Article  CAS  PubMed  Google Scholar 

  51. Cobb CM (2006) Lasers in periodontics: a review of the literature. J Periodontol 77:545–564

    Article  CAS  PubMed  Google Scholar 

  52. Qadri T, Miranda L, Tunér J, Gustafsson A (2005) The short-term effects of low-level lasers as adjunct therapy in the treatment of periodontal inflammation. J Clin Periodontol 32:714–719

    Article  CAS  PubMed  Google Scholar 

  53. Frentzen M, Koort HJ (1990) Lasers in dentistry: new possibilities with advancing laser technology? Int Dent J 40:323–332

    CAS  PubMed  Google Scholar 

  54. Wainwright M, Crossley KB (2004) Photosensitizing agents – circumventing resistance and breaking down biofilms: a review. Int Biodeterior Biodegrad 53:119–126

    Article  CAS  Google Scholar 

  55. Meisel P, Kocher T (2005) Photodynamic therapy for periodontal diseases: state of the art. J Photochem Photobiol B 79:159–170

    Article  CAS  PubMed  Google Scholar 

  56. Kvaal SI, Warloe T (2007) Photodynamic treatment of oral lesions. J Environ Pathol Toxicol Oncol 26:127–133

    CAS  PubMed  Google Scholar 

  57. Jori G (2006) Photodynamic therapy of microbial infections: state of art and perspectives. J Environ Pathol Toxicol Oncol 25:505–519

    PubMed  Google Scholar 

  58. Komerik N, MacRobert AJ (2006) Photodynamic therapy as an alternative antimicrobial modality for oral infections. J Environ Pathol Toxicol Oncol 25:487–504

    PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Sir John Walsh Research Institute, School of Dentistry, University of Otago, PO Box 647, Dunedin, New Zealand

    Momen A. Atieh

Authors
  1. Momen A. Atieh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Momen A. Atieh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Atieh, M.A. Photodynamic therapy as an adjunctive treatment for chronic periodontitis: a meta-analysis. Lasers Med Sci 25, 605–613 (2010). https://doi.org/10.1007/s10103-009-0744-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10103-009-0744-6

Keywords

Search

Navigation