Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China.
Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan, People's Republic of China, 430079.
Lasers Med Sci. 2022 Oct;37(8):3051-3066. doi: 10.1007/s10103-022-03592-2. Epub 2022 Jul 27.
Antimicrobial photodynamic therapy (aPDT) has been proposed as an adjunctive treatment strategy for peri-implant diseases. This systematic review aimed to determine whether aPDT as an adjunct to mechanical debridement has an additional benefit for smokers with peri-implant diseases. Randomized controlled trials (RCTs), which evaluated the clinical outcomes of mechanical debridement alone versus mechanical debridement + aPDT among smokers, were considered eligible to be included. The primary outcome was bleeding on probing (BOP) and secondary outcomes included probing depth (PD), plaque index (PI), and crestal bone loss (CBL). Meta-analyses using a random-effects model were conducted to calculate the mean difference (MD) with a 95% confidence interval (CI). The quality of evidence was assessed according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of four RCTs (188 participants) were included. The aPDT group showed significantly improved PD (MD = - 1.26, 95% CI = - 2.19 to - 0.32, p = 0.008) and PI (MD = - 10.6%, 95% CI = - 14.46 to - 6.74%, p = 0.0001) compared with mechanical debridement group at 3-month follow-up. No significant difference in bleeding on probing (BOP) was observed at 3-month follow-up (MD = - 0.60%, 95% CI = - 2.36 to 1.16%, p = 0.50). The subgroup analyses on photosensitizers demonstrated significant differences between the two groups on PD (MD = - 1.23, 95% CI = - 2.41 to - 0.05, p = 0.04) and PI (MD = - 12.33, 95% CI = - 14.74 to - 9.92, p < 0.00001) by the use of methylene blue (MB). Within the limitation of this study, compared with mechanical debridement alone, combined use of aPDT was more effective in reducing PD and PI in smokers at 3-month follow-up. MB was a predictable photosensitizer for aPDT. However, the findings should be interpreted with caution due to the limited number of included studies, methodological deficiencies, and heterogeneity between studies.
牙周病的辅助治疗策略中提出了使用抗菌光动力疗法（aPDT）。本系统评价旨在确定 aPDT 是否对患有牙周病的吸烟者进行机械清创术有额外益处。纳入了评估单独机械清创术与机械清创术加 aPDT 对吸烟者的临床疗效的随机对照试验（RCT）。主要结局为探诊出血（BOP），次要结局包括探诊深度（PD）、菌斑指数（PI）和牙槽骨丧失（CBL）。采用随机效应模型进行荟萃分析，计算均数差值（MD）及其 95%置信区间（CI）。根据推荐评估、制定与评估分级（GRADE）评估证据质量。共纳入 4 项 RCT（188 名参与者）。aPDT 组在 3 个月随访时 PD（MD=−1.26，95%CI=−2.19 至−0.32，p=0.008）和 PI（MD=−10.6%，95%CI=−14.46 至−6.74%，p=0.0001）显著改善。3 个月随访时，探诊出血（BOP）无显著差异（MD=−0.60%，95%CI=−2.36 至 1.16%，p=0.50）。亚组分析显示，两种光敏剂在 PD（MD=−1.23，95%CI=−2.41 至−0.05，p=0.04）和 PI（MD=−12.33，95%CI=−14.74 至−9.92，p<0.00001）方面有显著差异。本研究存在一定的局限性，与单独机械清创术相比，aPDT 联合治疗在 3 个月随访时更有效地降低了吸烟者的 PD 和 PI。亚甲基蓝（MB）是一种可预测的光动力疗法光敏剂。但是，由于纳入研究数量有限、方法学缺陷以及研究之间存在异质性，这些发现应谨慎解释。
