Cochrane · intervention · CD011778
Adjunctive antimicrobial photodynamic therapy for treating periodontal and peri‐implant diseases
Jervøe-Storm, P-M, Bunke, J, Worthington, HV, et al. · Cochrane Database of Systematic Reviews · 2024 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
37
current version
GRADE rated
10
No studies
15
Included studies
50
as reported
No studies 15 · 40.5%Ungraded 12 · 32.4%Very low 8 · 21.6%Low 0 · 0%Moderate 2 · 5.4%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (> 18 years) with a clinical diagnosis of periodontitis (aggressive or chronic per 1999 classification, or Stage II/III per 2017 World Workshop); adults with peri-implant mucositis; adults with peri-implantitis; included regardless of smoking status; excluded systemic disease/medication affecting periodontal disease, antibiotics within prior 6 months, and necrotising periodontitis | Adults with periodontitis in the active (non-surgical) phase (n=44 studies); adults with periodontitis in the supportive/maintenance phase (n=7 studies); adults with peri-implant mucositis (n=1 study, Al Rifaiy 2022, e-cigarette users); 50 RCTs, 1407 participants total (studies ranged from 10 to 88 participants); mostly non-smokers; none on antibiotics in the prior 6 months |
| Intervention | Adjunctive antimicrobial photodynamic therapy (aPDT) applied subgingivally after subgingival or submucosal instrumentation (SI); during active (non-surgical anti-infective) treatment or supportive (maintenance) treatment; single or multiple sessions; any photosensitising agent; laser or LED at any wavelength | Adjunctive aPDT after SI, single session (n=39 studies); multiple sessions of 2 to 4 (n=11 studies); one study included both single and multiple sessions; various photosensitisers with diode laser/LED devices; SI by hand or power-driven instrumentation, or both |
| Comparison | Subgingival/submucosal instrumentation (SI) alone (negative control; hand or power-driven, or both); or SI plus sham/placebo aPDT (sham laser device and sham photosensitising agent) | SI alone / negative control (n=45 studies); SI plus placebo/sham aPDT (n=5 studies) |
| Outcomes | Critical: Change in probing pocket depth (PPD)/probing depth (PD); Change in bleeding on probing (BOP); Change in clinical attachment level (CAL/RAL); Change in gingival recession (REC); Pocket closure (proportion of pockets changing from >= 5 mm to <= 4 mm); Any adverse effect related to aPDT. Other important: Change in bone level (peri-implantitis); Patient satisfaction; Quality of life | Change in PPD (n=15 studies at 6 months; n=35 at 3 months); Change in BOP (n=5 at 6 months; n=11 at 3 months); Change in CAL (n=13 at 6 months; n=34 at 3 months); Change in REC (n=4 at 6 months; n=13 at 3 months); Pocket closure (n=3 at 3 months; n=0 at 6 months); Any adverse effect related to aPDT (n=24 active, n=3 supportive); Patient satisfaction (n=0); Quality of life (n=0); Change in bone level (n=0) |
| Study designs | Randomised controlled trials (RCTs), parallel-group and split-mouth designs, with at least one month of follow-up (cross-over studies excluded) | RCT, split-mouth design (n=32); RCT, parallel-group design (n=18) |
| Timing | Change from baseline to three months or six months (six months prioritised for GRADE/SoF); bone level to end of study | Change from baseline measured at 3 months and 6 months (6 months prioritised for GRADE); the single peri-implant study reported at 3 months only |
Search date: 2024-02. Databases: Cochrane Oral Health Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; CINAHL EBSCO; AMED Ovid; ClinicalTrials.gov; WHO International Clinical Trials Registry Platform (ICTRP)
Questions and results
Adjunctive antimicrobial photodynamic therapy (aPDT) applied after subgingival instrumentation (SI) vs Subgingival instrumentation (SI) alone (hand or power-driven, or both), or SI plus placebo/sham aPDT
Population: Adults (> 18 years) with a clinical diagnosis of periodontitis, receiving active (non-surgical anti-infective) treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient satisfaction | No studies reported data for this outcome. | NR | No studies |
Any adverse effect related to aPDT | Risk with control: 23 studies reported that no adverse effects of aPDT were observed. Number of participants (studies): 639 (24 studies). Certainty: Moderate. (24 studies reported adverse effects, with all studies… | 24 studies · 639 participants | Moderate Downgraded: risk of bias |
Pocket closure 3 months (change from baseline) | Three studies evaluated the proportion of closed pockets three months after treatment (Al-Zahrani 2011; Courval 2020; Rodrigues 2023); studies used different criteria to measure this outcome. All studies reported an… | 3 studies | Ungraded |
Change in bleeding on probing (BOP) 6 months (change from baseline) | MD 5.72 [1.62, 9.81] | 5 studies · 171 participants | Very low Downgraded: risk of bias, inconsistency |
Pocket closure 6 months (change from baseline) | No studies measured this outcome at 6 months (SoF row labeled 'Change in pocket depth from baseline to 6 months after initial treatment'). | NR | No studies |
Quality of life | No studies reported data for this outcome. | NR | No studies |
Change in probing pocket depth (PPD) 6 months (change from baseline) | MD 0.52 [0.31, 0.74] | 15 studies · 452 participants | Very low Downgraded: risk of bias, inconsistency |
Change in clinical attachment level (CAL) 3 months (change from baseline) | MD 0.36 [0.24, 0.48] | 34 studies · 875 participants | Ungraded |
Change in probing pocket depth (PPD) 3 months (change from baseline) | MD 0.44 [0.29, 0.59] | 35 studies · 873 participants | Ungraded |
Change in bleeding on probing (BOP) 3 months (change from baseline) | MD 2.19 [1.00, 3.38] | 11 studies · 282 participants | Ungraded |
Change in gingival recession (REC) 6 months (change from baseline) | MD 0.00 [-0.16, 0.16] | 4 studies · 95 participants | Very low Downgraded: risk of bias, imprecision |
Change in clinical attachment level (CAL) 6 months (change from baseline) | MD 0.44 [0.24, 0.64] | 13 studies · 414 participants | Very low Downgraded: risk of bias, inconsistency |
Change in gingival recession (REC) 3 months (change from baseline) | MD -0.01 [-0.06, 0.05] | 13 studies · 284 participants | Ungraded |
Adjunctive antimicrobial photodynamic therapy (aPDT) applied after subgingival instrumentation (SI) vs Subgingival instrumentation (SI) alone (hand or power-driven, or both), or SI plus placebo/sham aPDT
Population: Adults (> 18 years) with recurrent periodontitis, receiving supportive (maintenance) periodontal care
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Change in bleeding on probing (BOP) 3 months (change from baseline) | MD 2.38 [-1.34, 6.10] | 5 studies · 231 participants | Ungraded |
Change in gingival recession (REC) 6 months (change from baseline) | MD -0.20 [-0.48, 0.08] | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision |
Change in gingival recession (REC) 3 months (change from baseline) | MD -0.01 [-0.27, 0.25] | 2 studies · 37 participants | Ungraded |
Change in bleeding on probing (BOP) 6 months (change from baseline) | MD 4.98 [-2.51, 12.46] | 3 studies · 127 participants | Very low Downgraded: risk of bias, inconsistency |
Change in clinical attachment level (CAL) 6 months (change from baseline) | MD 0.07 [-0.26, 0.40] | 2 studies · 85 participants | Very low Downgraded: risk of bias, imprecision |
Pocket closure 3 months (change from baseline) | Three studies evaluated the proportion of closed pockets three months after treatment (Campos 2013; Grzech-Lesniak 2019; Ruhling 2010); studies used different criteria to measure this outcome. All studies reported an… | 3 studies | Ungraded |
Quality of life | No studies reported data for this outcome. | NR | No studies |
Change in probing pocket depth (PPD) 3 months (change from baseline) | MD 0.44 [-0.20, 1.08] | 6 studies · 244 participants | Ungraded |
Patient satisfaction | No studies reported data for this outcome. | NR | No studies |
Change in probing pocket depth (PPD) 6 months (change from baseline) | MD -0.04 [-0.19, 0.10] | 3 studies · 125 participants | Very low Downgraded: risk of bias, imprecision |
Change in clinical attachment level (CAL) 3 months (change from baseline) | MD 0.07 [-0.21, 0.36] | 5 studies · 204 participants | Ungraded |
Pocket closure 6 months (change from baseline) | No studies measured this outcome at 6 months (SoF row labeled 'Change in pocket depth from baseline to 6 months after treatment'); no studies reported these data at six months after treatment. | NR | No studies |
Any adverse effect related to aPDT | Risk with control: In 1 study, 1 participant had an abscess (not specified if this was related to aPDT). In 2 other studies, no adverse effects of aPDT were observed. Number of participants (studies): 134 (3 RCTs).… | 3 studies · 134 participants | Moderate Downgraded: risk of bias |
Adjunctive antimicrobial photodynamic therapy (aPDT) applied after submucosal instrumentation (SI) vs Submucosal instrumentation (SI) alone, or SI plus placebo/sham aPDT
Population: Adults (> 18 years) with peri-implant mucositis, receiving active treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quality of life | Only one study reported evidence for adjunctive aPDT in people with peri-implant disease (Al Rifaiy 2022). Data were only available for two outcomes (PPD and BOP), both reported only at three months. No studies… | NR | No studies |
Change in gingival recession (REC) | Only one study reported evidence for adjunctive aPDT in people with peri-implant disease (Al Rifaiy 2022). Data were only available for two outcomes (PPD and BOP), both reported only at three months. No studies… | NR | No studies |
Any adverse effect related to aPDT | Only one study reported evidence for adjunctive aPDT in people with peri-implant disease (Al Rifaiy 2022). Data were only available for two outcomes (PPD and BOP), both reported only at three months. No studies… | NR | No studies |
Patient satisfaction | Only one study reported evidence for adjunctive aPDT in people with peri-implant disease (Al Rifaiy 2022). Data were only available for two outcomes (PPD and BOP), both reported only at three months. No studies… | NR | No studies |
Change in probing depth (PD/PPD) 3 months (change from baseline) | MD -0.10 [-0.57, 0.37] | 1 study · 38 participants | Ungraded |
Pocket closure | Only one study reported evidence for adjunctive aPDT in people with peri-implant disease (Al Rifaiy 2022). Data were only available for two outcomes (PPD and BOP), both reported only at three months. No studies… | NR | No studies |
Change in clinical attachment level (CAL) | Only one study reported evidence for adjunctive aPDT in people with peri-implant disease (Al Rifaiy 2022). Data were only available for two outcomes (PPD and BOP), both reported only at three months. No studies… | NR | No studies |
Change in bleeding on probing (BOP) 3 months (change from baseline) | MD 1.60 [0.27, 2.93] | 1 study · 38 participants | Ungraded |
Adjunctive antimicrobial photodynamic therapy (aPDT) applied after submucosal instrumentation (SI) vs Submucosal instrumentation (SI) alone, or SI plus placebo/sham aPDT
Population: Adults (> 18 years) with peri-implant mucositis, receiving supportive treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Planned comparison; no studies met the inclusion criteria. The review found only one study of peri-implant disease (peri-implant mucositis, active treatment) and no studies including people with peri-implantitis… | NR | No studies |
Adjunctive antimicrobial photodynamic therapy (aPDT) applied after submucosal instrumentation (SI) vs Submucosal instrumentation (SI) alone, or SI plus placebo/sham aPDT
Population: Adults (> 18 years) with peri-implantitis, receiving active treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Planned comparison; no studies met the inclusion criteria. The review found only one study of peri-implant disease (peri-implant mucositis, active treatment) and no studies including people with peri-implantitis… | NR | No studies |
Adjunctive antimicrobial photodynamic therapy (aPDT) applied after submucosal instrumentation (SI) vs Submucosal instrumentation (SI) alone, or SI plus placebo/sham aPDT
Population: Adults (> 18 years) with peri-implantitis, receiving supportive treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Planned comparison; no studies met the inclusion criteria. The review found only one study of peri-implant disease (peri-implant mucositis, active treatment) and no studies including people with peri-implantitis… | NR | No studies |