Adjunctive photodynamic therapy to non-surgical treatment of chronic periodontitis: a systematic review and meta-analysis

Aim To investigate the efficacy of antimicrobial photodynamic therapy (aPDT) adjunctive to scaling root planing (SRP) in patients with chronic periodontitis. Methods A meta-analysis was conducted according to the PRISMA statement and Cochrane Collaboration recommendations. Two independent reviewers performed an extensive literature search and manual search on seven databases. Mean differences (MD) and 95% confidence intervals (CI) were calculated for clinical attachment level (CAL) gain and probing depth (PD) reduction. The I2 test was used for inter-study heterogeneity. Publication bias was examined by Egger's regression test and the trim-and-fill method. Results Sensitivity analysis of 14 randomized clinical trials (RCTs) revealed differences in PD reduction (MD 0.19, 95% CI 0.070.31, p=0.002) and CAL gain (MD 0.37, 95% CI 0.260.47, p<0.0001) in favour of SRP+aPDT, with no evidence of heterogeneity. Subgroup analysis revealed the absence of heterogeneity in RCTs, with high risk of bias for PD reduction and CAL gain. No evidence of publication bias was detected. Conclusions The use of adjunctive aPDT to conventional SRP provides short-term benefits. The evidence to support its clinical medium/long-term efficacy is insufficient. Further high-quality RCTs are needed to investigate the influence of potential confounders on the efficacy of adjunctive aPDT.