Zohaib Akram1, Tahira Hyder2, Nawwaf Al-Hamoudi3, Munerah Saleh Binshabaib4, Shatha Subhi Alharthi4, Ayesha Hanif2. 1. Department of Periodontology, Faculty of Dentistry, Ziauddin University, Karachi, Pakistan. Electronic address: drzohaibakram@gmail.com. 2. Department of Periodontology, Faculty of Dentistry, Ziauddin University, Karachi, Pakistan. 3. Department of Periodontics and Community Dentistry, King Saud University, Riyadh, Saudi Arabia. 4. Department of Periodontology, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
Abstract
BACKGROUND: To determine whether treatment with antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) yield better clinical periodontal outcomes than antibiotics (AB) as adjunct to SRP in periodontitis. METHODS: Electronic searches were conducted in databases (MEDLINE, PubMed, EMBASE, SCOPUS, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) up to and including April 2017. RESULTS: Five randomized trials were included. All studies used the combined approach aPDT+SRP and AB+SRP in the test and control group respectively. The follow up period ranged from 12 to 48 weeks. All studies used diode lasers. The wavelengths, power density and duration of irradiation used were 670 nanometre, 75 milliwatts per square centimeters and 60s respectively. None of the studies showed additional benefits of aPDT at follow up. Considering the effects of adjunctive aPDT as compared to AB, a high degree of heterogeneity for periodontal probing depth (PPD) (p<0.0001, I2=87.47%) was noticed among both the groups. Meta-analysis showed significant clinical attachment level (CAL) gain (WMD=0.60, 95% CI=0.25 to 0.95, p=0.001), and not PPD reduction (WMD=0.67, 95% CI=-0.36 to 1.71, p=0.204) for aPDT as compared to AB at follow up. CONCLUSION: It remains debatable whether aPDT is more effective as compared to adjunctive AB in the treatment of periodontitis, given that the scientific evidence is weak. Precautions must be exercised when interpreting the results of this study due to the small sample size and high heterogeneity among studies.
BACKGROUND: To determine whether treatment with antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) yield better clinical periodontal outcomes than antibiotics (AB) as adjunct to SRP in periodontitis. METHODS: Electronic searches were conducted in databases (MEDLINE, PubMed, EMBASE, SCOPUS, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) up to and including April 2017. RESULTS: Five randomized trials were included. All studies used the combined approach aPDT+SRP and AB+SRP in the test and control group respectively. The follow up period ranged from 12 to 48 weeks. All studies used diode lasers. The wavelengths, power density and duration of irradiation used were 670 nanometre, 75 milliwatts per square centimeters and 60s respectively. None of the studies showed additional benefits of aPDT at follow up. Considering the effects of adjunctive aPDT as compared to AB, a high degree of heterogeneity for periodontal probing depth (PPD) (p<0.0001, I2=87.47%) was noticed among both the groups. Meta-analysis showed significant clinical attachment level (CAL) gain (WMD=0.60, 95% CI=0.25 to 0.95, p=0.001), and not PPD reduction (WMD=0.67, 95% CI=-0.36 to 1.71, p=0.204) for aPDT as compared to AB at follow up. CONCLUSION: It remains debatable whether aPDT is more effective as compared to adjunctive AB in the treatment of periodontitis, given that the scientific evidence is weak. Precautions must be exercised when interpreting the results of this study due to the small sample size and high heterogeneity among studies.