Wang Peng, Sun Fei, Ling Xiaoxu
Department of Periodontology, Shaoxing Stomatological Hospital, Shaoxing City, 312000, PR China.
Department of Endodontics, Shaoxing Stomatological Hospital, Shaoxing City, 312000, PR China.
J Stomatol Oral Maxillofac Surg. 2025 Mar;126(2):102036. doi: 10.1016/j.jormas.2024.102036. Epub 2024 Sep 5.
Periodontitis is a prevalent inflammatory disease affecting the supporting structures of teeth. While scaling and root planing (SRP) remains the gold standard for treatment, adjunctive therapies are being explored to enhance outcomes. This systematic review and meta-analysis aimed to evaluate the effectiveness of photodynamic therapy (PDT) as an adjunct to SRP in the treatment of periodontitis.
A comprehensive literature search was conducted in PubMed, Embase, Web of Science, CNKI, Wanfang, and Weipu databases. Randomized controlled trials (RCTs) comparing SRP alone to SRP with adjunctive PDT were included. The primary outcomes were changes in clinical attachment level (CAL) and probing depth (PD). Secondary outcomes included plaque index (PI). Random-effects models were used for meta-analysis, and heterogeneity was assessed using I² statistics.
Eighteen RCTs met the inclusion criteria. Meta-analysis revealed that adjunctive PDT significantly improved CAL (SMD: -0.16; 95% CI: -0.40, -0.07; P < 0.001; I² = 60.7%) and PD (SMD: -0.55; 95% CI: -0.97, -0.13; P < 0.001; I² = 76.2%) compared to SRP alone. PI also showed improvement with adjunctive PDT (SMD: -0.40; 95% CI: -0.67, -0.14; P = 0.072; I² = 43.0%). Egger's test indicated a borderline significant publication bias for CAL, while no significant publication bias for PD.
This meta-analysis provides evidence that PDT as an adjunct to SRP can significantly improve clinical outcomes in periodontitis treatment. However, the high heterogeneity observed suggests that optimal PDT protocols need further investigation. Future research should focus on standardizing PDT parameters and exploring its long-term effects.
牙周炎是一种影响牙齿支持结构的常见炎症性疾病。虽然龈上洁治术和根面平整术（SRP）仍然是治疗的金标准，但正在探索辅助治疗方法以提高治疗效果。本系统评价和荟萃分析旨在评估光动力疗法（PDT）作为SRP辅助治疗牙周炎的有效性。
在PubMed、Embase、Web of Science、中国知网、万方和维普数据库中进行了全面的文献检索。纳入比较单纯SRP与联合PDT的SRP的随机对照试验（RCT）。主要结局是临床附着水平（CAL）和探诊深度（PD）的变化。次要结局包括菌斑指数（PI）。采用随机效应模型进行荟萃分析，并使用I²统计量评估异质性。
18项RCT符合纳入标准。荟萃分析显示，与单纯SRP相比，辅助PDT显著改善了CAL（标准化均数差：-0.16；95%可信区间：-0.40，-0.07；P<0.001；I²=60.7%）和PD（标准化均数差：-0.55；95%可信区间：-0.97，-0.13；P<0.001；I²=76.2%）。PI在辅助PDT治疗时也有所改善（标准化均数差：-0.40；95%可信区间：-0.67，-0.14；P=0.072；I²=43.0%）。Egger检验表明CAL存在临界显著的发表偏倚，而PD无显著发表偏倚。
本荟萃分析提供的证据表明，PDT作为SRP的辅助治疗可显著改善牙周炎治疗的临床结局。然而，观察到的高异质性表明，最佳的PDT方案需要进一步研究。未来的研究应侧重于标准化PDT参数并探索其长期效果。
