Warakomska Aleksandra, Fiegler-Rudol Jakub, Kubizna Magdalena, Skaba Dariusz, Wiench Rafał
Department of Periodontal Diseases and Oral Mucosa Diseases, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland.
Department of Oral Surgery, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland.
Pharmaceutics. 2025 Mar 30;17(4):443. doi: 10.3390/pharmaceutics17040443.
: Peri-implantitis, an inflammatory condition leading to progressive bone loss around dental implants, represents a significant challenge in modern implant dentistry. Conventional mechanical debridement and adjunctive antibiotics or antiseptics often fail to fully eradicate complex biofilms and may promote antibiotic resistance. Photodynamic therapy (PDT) mediated by natural photosensitizers (e.g., curcumin, riboflavin, and 5-aminolevulinic acid) has emerged as a potential adjunctive strategy for peri-implantitis management due to its targeted antimicrobial and anti-inflammatory effects. : This systematic review aimed to evaluate the antimicrobial efficacy, clinical outcomes, and safety of PDT mediated by natural photosensitizers in the treatment of peri-implantitis and to identify optimal protocols regarding photosensitizer concentrations, light source parameters, and application techniques. Methods: Following PRISMA 2020 guidelines, databases (PubMed/Medline, Embase, Scopus, and Cochrane Library) were searched from 1 January 2015 to 3 January 2025 for English-language publications. Studies assessing naturally based PDT interventions for peri-implantitis or in vitro biofilms from diseased implant surfaces were included. Quality assessment used the Revised Cochrane Risk of Bias tool (RoB 2) for randomized controlled trials and a tailored nine-item framework for in vitro studies. Eleven studies met the inclusion criteria. : Despite heterogeneity in methodologies, especially regarding light wavelengths, energy densities, and photosensitizer formulations, most studies reported notable reductions in bacterial viability, biofilm mass, and clinical indices (probing depth and bleeding on probing). Curcumin and riboflavin frequently demonstrated comparable antimicrobial efficacy to standard disinfectants, while 5-aminolevulinic acid (5-ALA)-based PDT also showed promising clinical and microbiological improvements. However, complete biofilm eradication was rarely achieved. : Natural-photosensitizer-based PDT appears to be a valuable adjunct to mechanical debridement for peri-implantitis, enhancing microbial control and clinical outcomes. Standardization of PDT protocols and further well-designed clinical trials with extended follow-up periods are warranted to confirm long-term efficacy and inform evidence-based guidelines.
种植体周围炎是一种导致牙种植体周围骨质进行性丧失的炎症性疾病，是现代种植牙科面临的一项重大挑战。传统的机械清创术以及辅助使用抗生素或防腐剂往往无法完全根除复杂的生物膜，还可能会促进抗生素耐药性的产生。由天然光敏剂（如姜黄素、核黄素和5-氨基乙酰丙酸）介导的光动力疗法（PDT），因其具有针对性的抗菌和抗炎作用，已成为一种治疗种植体周围炎的潜在辅助策略。：本系统评价旨在评估天然光敏剂介导的光动力疗法在治疗种植体周围炎方面的抗菌效果、临床疗效和安全性，并确定关于光敏剂浓度、光源参数和应用技术的最佳方案。方法：按照PRISMA 2020指南，检索了2015年1月1日至2025年1月3日的数据库（PubMed/Medline、Embase、Scopus和Cochrane图书馆），以查找英文出版物。纳入评估基于天然物质的光动力疗法干预种植体周围炎或患病种植体表面体外生物膜的研究。质量评估对随机对照试验使用修订后的Cochrane偏倚风险工具（RoB 2），对体外研究使用定制的九项框架。11项研究符合纳入标准。：尽管方法存在异质性，尤其是在光波长、能量密度和光敏剂配方方面，但大多数研究报告称，细菌活力、生物膜量和临床指标（探诊深度和探诊出血）均有显著降低。姜黄素和核黄素通常表现出与标准消毒剂相当的抗菌效果，而基于5-氨基乙酰丙酸（5-ALA）的光动力疗法也显示出有前景的临床和微生物学改善。然而，很少能实现生物膜的完全根除。：基于天然光敏剂的光动力疗法似乎是种植体周围炎机械清创术的一种有价值的辅助手段，可增强微生物控制和临床疗效。有必要对光动力疗法方案进行标准化，并开展进一步设计良好、随访期延长的临床试验，以确认其长期疗效并为循证指南提供依据。
