Effectiveness of Photodynamic Therapy in the Treatment of Periodontal and Peri-Implant Diseases.

During the last decade, photodynamic therapy (PDT) has been extensively investigated for the treatment of periodontal and peri-implant infections. Nonetheless, contradicting clinical and microbiological outcomes and only results on a short-term basis have been reported so far, thus making it difficult to conclude on clinically relevant recommendations for the use of PDT. Therefore, the aim of this narrative review is to provide an overview of the current evidence from randomized controlled clinical trials (RCTs) evaluating the potential clinical and/or microbiological benefit for the use of PDT in non-surgical periodontal and peri-implant therapy, and to draw clinically relevant conclusions on the use of PDT in periodontal practice. Based on the available evidence from RCTs and recent meta-analyses, we can conclude the following: in patients with mild to moderate periodontitis, the combination of scaling and root planing (SRP) and PDT may result in significantly higher clinical improvements (bleeding on probing and probing depth reduction, clinical attachment gain) compared to SRP alone in the non-surgical treatment of periodontitis; in patients with stage III and IV grade C periodontitis (previously known as AgP) the use of PDT provides clinical improvements, although PDT cannot so far be recommended as a replacement for systemic antibiotics (i.e., amoxicillin and metronidazole); PDT may be indicated as a valuable tool for treating moderate residual periodontal pockets during maintenance therapy; limited evidence on the use of PDT in medically compromised patients (i.e., diabetes mellitus, oral lichen planus) indicates that PDT may represent a possible alternative to other more invasive medication/treatment procedures; limited evidence suggests that PDT may represent a valuable tool in attaining inflammation reduction on a short-term basis in peri-implant diseases (i.e., peri-implantitis, peri-implant mucositis).