Rodrigues João Victor Soares, Deroide Mariella Boaretti, Takeshita Wilton Mitsunari, Garcia Valdir Gouveia, de Molon Rafael Scaf, Theodoro Leticia Helena
Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University (UNESP), Araçatuba 16015-050, SP, Brazil.
Latin American Institute of Dental Research and Teaching (ILAPEO), Curitiba 80710-150, PR, Brazil.
Dent J (Basel). 2025 Jan 2;13(1):21. doi: 10.3390/dj13010021.
Diabetes mellitus and periodontitis share a significant, bidirectional relationship. Diabetes raises the risk of periodontitis and influences its severity, impacting tissue repair and bone metabolism. Conversely, periodontal inflammation can disrupt glycemic control, further complicating this interlinked relationship. This systematic review aimed to evaluate the efficacy of antimicrobial photodynamic therapy (aPDT) as an adjunct to subgingival instrumentation (SI) in the treatment of periodontal pockets with a probing pocket depth (PPD) ≥ 5 mm in individuals with type 2 diabetes mellitus (DM2) and periodontitis. Using the PICOS framework, this review addressed the following question: "How does aPDT as an adjunct to SI compare to SI alone in treating periodontal pockets with PPD ≥ 5 mm in individuals with DM2 and periodontitis?" Databases searched included PubMed, Scopus, and Web of Science up to December 2024. Randomized clinical trials evaluating periodontal status and HbA1c levels in patients with DM2 undergoing periodontal therapy and experiencing SI were included. Patients who received adjunctive aPDT were compared to a control group that received SI alone. A meta-analysis was conducted illustrating treatment effects across groups. After screening 117 studies based on titles and abstracts, three and four studies met the eligibility criteria for quantitative and qualitative analyses, respectively. The principal periodontal parameters assessed included PPD, clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BOP). Forest plots for PD, BOP, PI, and CAL at baseline, three months, and six months revealed no statistically significant differences between the SI+aPDT group and the SI-only group. Glycated hemoglobin across treatment groups was not different. The combination of aPDT with SI provides limited clinical benefits in treating periodontal pockets with a PPD ≥ 5 mm in diabetic patients with periodontitis.
糖尿病与牙周炎存在显著的双向关系。糖尿病会增加患牙周炎的风险并影响其严重程度，对组织修复和骨代谢产生影响。相反，牙周炎症会破坏血糖控制，使这种相互关联的关系更加复杂。本系统评价旨在评估抗菌光动力疗法（aPDT）作为龈下器械刮治术（SI）辅助手段，用于治疗2型糖尿病（DM2）合并牙周炎且探诊袋深度（PPD）≥5 mm患者牙周袋的疗效。本评价使用PICOS框架，解决了以下问题：“在治疗DM2合并牙周炎且PPD≥5 mm的患者的牙周袋时，aPDT作为SI的辅助手段与单独使用SI相比效果如何？”检索的数据库包括截至2024年12月的PubMed、Scopus和科学网。纳入了评估接受牙周治疗并进行SI的DM2患者牙周状况和糖化血红蛋白水平的随机临床试验。将接受辅助aPDT的患者与仅接受SI的对照组进行比较。进行了荟萃分析以说明各组的治疗效果。在根据标题和摘要筛选117项研究后，分别有三项和四项研究符合定量和定性分析的纳入标准。评估的主要牙周参数包括PPD、临床附着水平（CAL）、菌斑指数（PI）和探诊出血（BOP）。基线、三个月和六个月时PD、BOP、PI和CAL的森林图显示，SI+aPDT组和仅SI组之间无统计学显著差异。各治疗组的糖化血红蛋白无差异。aPDT与SI联合使用在治疗DM2合并牙周炎且PPD≥5 mm的患者的牙周袋方面临床益处有限。
