Cieplik Fabian, Buchalla Wolfgang, Hellwig Elmar, Al-Ahmad Ali, Hiller Karl-Anton, Maisch Tim, Karygianni Lamprini
Department of Conservative Dentistry and Periodontology, University Medical Center Regensburg, Regensburg, Germany.
Department of Conservative Dentistry and Periodontology, University Medical Center Regensburg, Regensburg, Germany.
Photodiagnosis Photodyn Ther. 2017 Jun;18:54-62. doi: 10.1016/j.pdpdt.2017.01.005. Epub 2017 Jan 15.
For deep carious lesions, a more conservative treatment modality ("selective caries removal") has been proposed, where only the heavily contaminated dentine is removed. In this regard, effective adjuncts for cavity disinfection such as the antimicrobial photodynamic therapy (aPDT) can be valuable clinically prior to definitive restoration. Therefore, the aim of this study was to systematically assess clinical studies on the effectiveness of aPDT as a supplementary tool in the treatment of deep caries lesions. Searches were performed in four databases (PubMed, EMBASE, ISI Web of Science, ClinicalTrials.gov) from 1st January, 2011 until 21st June, 2016 for search terms relevant to the observed parameters, pathological condition, intervention and anatomic entity. The pooled information was evaluated according to PRISMA guidelines. At first, 1651 articles were recovered, of which 1249 full-text articles were evaluated, 270 articles thereof were reviewed for eligibility and finally 6 articles met all inclusion criteria. The aPDT protocols involved Methylene Blue, Toluidine Blue and aluminium-chloride-phthalocyanine as photosensitizers and diode lasers, light-emitting diodes and halogen light-sources. The data from five reports, utilizing both culture-dependent and -independent methods, disclosed significant reduction of cariogenic bacterial load after mechanical caries removal with adjunct aPDT. As these studies exhibit some methodological limitations, e.g. lack of positive controls, this systematic review can support the application of aPDT to a limited extent only in terms of reducing the microbial load in deep carious lesions before restorative treatment.
对于深龋病变，已提出一种更为保守的治疗方式（“选择性龋损去除”），即仅去除严重污染的牙本质。在这方面，诸如抗菌光动力疗法（aPDT）等有效的窝洞消毒辅助手段在最终修复前可能具有重要的临床价值。因此，本研究的目的是系统评估关于aPDT作为治疗深龋病变辅助工具有效性的临床研究。在2011年1月1日至2016年6月21日期间，在四个数据库（PubMed、EMBASE、ISI科学网、ClinicalTrials.gov）中进行检索，以查找与观察参数、病理状况、干预措施和解剖实体相关的检索词。根据PRISMA指南对汇总信息进行评估。最初检索到1651篇文章，其中对1249篇全文进行了评估，对其中270篇文章进行了资格审查，最终有6篇文章符合所有纳入标准。aPDT方案涉及使用亚甲蓝、甲苯胺蓝和铝氯酞菁作为光敏剂，以及二极管激光器、发光二极管和卤素光源。来自五份报告的数据，采用了依赖培养和不依赖培养的方法，揭示了在机械去除龋损并辅助aPDT后，致龋菌负荷显著降低。由于这些研究存在一些方法学上的局限性，例如缺乏阳性对照，本系统评价仅能在有限程度上支持aPDT在修复治疗前降低深龋病变中微生物负荷方面的应用。
