School of Dentistry, Ibirapuera University (Unib), São Paulo, Brazil.
Unit of Basic Oral Investigation (UIBO), School of Dentistry, El Bosque University, Bogota, Colombia.
J Periodontol. 2018 Jul;89(7):783-803. doi: 10.1902/jop.2017.170172.
This systematic review evaluates the efficacy of antimicrobial photodynamic therapy (aPDT), as an adjunct to non-surgical or surgical therapy, on clinical and patient-centered outcomes in patients with periodontitis or peri-implantitis.
Randomized controlled trials (RCTs) with a follow-up duration ≥ 3 months that evaluated mechanical root/implant surface debridement (i.e., scaling and root planing [SRP] or implant surface scaling [ISS]) versus SRP or ISS plus aPDT for the treatment of adult patients (≥ 18 years old) with moderate-to-severe chronic (CP)/aggressive periodontitis (AgP) or peri-implantitis, respectively, were considered eligible for inclusion. The MEDLINE, EMBASE, and CENTRAL databases were searched for articles published up to and including March 2017. Random-effects meta-analyses were used throughout the review using continuous data (i.e., mean changes from baseline), and pooled estimates were expressed as weighted mean differences with their associated 95% confidence intervals. Additionally, summaries are presented of the included RCTs, critical remarks of the literature, and evidence quality rating/strength of recommendation of laser procedures.
Of 729 potentially eligible articles, 28 papers (26 studies) were included in the review. Individual study outcomes and four sets of meta-analysis showed potential statistical significant benefit of aPDT in improving clinical attachment level (CAL) (non-surgical treatment of AgP) and probing depth (PD) (non-surgical treatment of AgP and CP). However, the comparative differences in clinical outcomes were modest (< 1 mm), and the level of certainty for different therapies was considered low-to-moderate (i.e., more information would be necessary to allow for a reliable and definitive estimation of effect/magnitude of therapies on health outcomes). Overall, most of the strengths of clinical recommendations of aPDT were guided by the expert opinion.
aPDT may provide similar clinical improvements in PD and CAL when compared with conventional periodontal therapy for both periodontitis and peri-implantitis patients. The restricted base of evidence for some treatment approaches and conditions precludes additional conclusions.
本系统评价评估了抗菌光动力疗法（aPDT）作为非手术或手术治疗的辅助手段，在牙周炎或种植体周围炎患者的临床和以患者为中心的结局方面的疗效。
纳入了随访时间≥3 个月的随机对照试验（RCT），这些 RCT 评估了机械根/种植体表面清创（即刮治和根面平整[SRP]或种植体表面刮治[ISS]）与 SRP 或 ISS 加 aPDT 治疗中重度慢性（CP）/侵袭性牙周炎（AgP）或种植体周围炎的疗效，分别为成年患者（≥18 岁）。纳入了截止到 2017 年 3 月发表的 MEDLINE、EMBASE 和 CENTRAL 数据库中的文章。本综述通篇使用随机效应荟萃分析对连续数据（即，从基线的平均变化）进行分析，汇总估计值表示为加权均数差值及其相关 95%置信区间。此外，还呈现了纳入 RCT 的总结、文献的关键评论以及激光治疗程序的证据质量评级/推荐强度。
在 729 篇潜在合格的文章中，有 28 篇论文（26 项研究）纳入了本综述。个别研究结果和四组荟萃分析表明，aPDT 在改善临床附着水平（CAL）（AgP 的非手术治疗）和探诊深度（PD）（AgP 和 CP 的非手术治疗）方面具有潜在的统计学显著益处。然而，临床结局的比较差异较小（＜1mm），不同治疗方法的确定性水平被认为是低到中度（即，需要更多的信息才能对治疗对健康结果的影响/程度进行可靠和明确的估计）。总体而言，aPDT 的大部分临床推荐的优势是基于专家意见。
与传统牙周治疗相比，aPDT 可能在 PD 和 CAL 方面为牙周炎和种植体周围炎患者提供相似的临床改善。一些治疗方法和条件的证据基础有限，无法得出更多结论。
