Yan Yumeng, Rotundo Roberto, Suvan Jeanie, Orlandi Marco, Poma Alessandro, D'Aiuto Francesco
Periodontology Unit, UCL Eastman Dental Institute, London, United Kingdom.
Periodontology Unit, University Vita-Salute San Raffaele, Milan, Italy.
Front Oral Health. 2025 Jul 9;6:1614982. doi: 10.3389/froh.2025.1614982. eCollection 2025.
This systematic review aimed to evaluate the antimicrobial efficacy of photodynamic therapy (PDT) in treating peri-implant diseases when combined with mechanical debridement (MD) compared with mechanical debridement alone.
A systematic review was completed according to PRISMA guidelines. The following databases, Cochrane Central Register for Controlled Trials (CENTRAL), Medline, Embase, Dentistry & Oral Sciences Source, Scopus, LILACS, and China Online, were searched based on the search strategies and hand search without language limitation until 15 June 2024. Only randomised controlled trials were included, assessing the efficacy of PDT used in combination with either surgical or non-surgical MD, compared with MD alone in participants with peri-implant diseases. Risk of bias for randomised controlled trials was assessed according to the recommendation of the Cochrane Reviewers' Handbook using the revised Cochrane tool. All outcomes were evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
A total of 26 studies were included in this study, of which 6 were categorised as low risk of bias, 9 were with some concern, and 11 were at high risk of bias. Nineteen studies were included in the quantitative analysis. At 3 months, PDT combined with non-surgical MD significantly reduced probing pocket depth (PPD) in peri-implant mucositis (-0.95 mm, 95% CI: -1.76 to -0.14) and peri-implantitis (-0.86 mm, 95% CI: -1.21 to -0.51) compared with MD alone. At 6 months, PPD reductions in peri-implantitis remained significant with non-surgical MD + PDT (-0.83 mm, 95% CI: -1.62 to -0.04) and surgical MD + PDT (-0.56 mm, 95% CI: -0.85 to -0.27). Non-surgical MD + PDT also reduced bleeding on probing (BoP) (-11.65% at 3 months, -6.76% at 6 months) and crestal bone loss (CBL) (-0.24 mm at 3 months, -0.28 mm at 6 months).
PDT enhances antimicrobial efficacy in peri-implant disease treatment, significantly improving PPD, CBL, and BoP when combined with MD. However, due to the overall moderate-to-low certainty of the evidence and some concerns regarding risk of bias in the included studies, these findings should be interpreted with caution. Further high-quality, well-designed randomised controlled trials are warranted to confirm these effects and optimise treatment protocols.
PROSPERO CRD42021262889.
本系统评价旨在评估光动力疗法（PDT）联合机械清创术（MD）治疗种植体周围疾病与单纯机械清创术相比的抗菌效果。
根据PRISMA指南完成系统评价。基于检索策略，对以下数据库进行检索：Cochrane对照试验中心注册库（CENTRAL）、医学期刊数据库（Medline）、荷兰医学文摘数据库（Embase）、牙科学与口腔科学来源数据库、Scopus数据库、拉丁美洲及加勒比地区卫生科学数据库（LILACS）和中国知网，同时进行手工检索，检索截至2024年6月15日，无语言限制。仅纳入随机对照试验，评估PDT联合手术或非手术MD与单纯MD相比，在种植体周围疾病患者中的疗效。根据Cochrane评价员手册的建议，使用修订后的Cochrane工具评估随机对照试验的偏倚风险。所有结局均采用推荐分级的评估、制定和评价（GRADE）方法进行评估。
本研究共纳入26项研究，其中6项被归类为低偏倚风险，9项存在一定担忧，11项为高偏倚风险。19项研究纳入定量分析。在3个月时，与单纯MD相比，PDT联合非手术MD显著降低了种植体周围黏膜炎的探诊深度（PPD）（-0.95 mm，95%CI：-1.76至-0.14）和种植体周围炎的PPD（-0.86 mm，95%CI：-1.21至-0.51）。在6个月时，非手术MD联合PDT（-0.83 mm，95%CI：-1.62至-0.04）和手术MD联合PDT（-0.56 mm，95%CI：-0.85至-0.27）在种植体周围炎中的PPD降低仍具有显著性。非手术MD联合PDT还降低了探诊出血（BoP）（3个月时为-11.65%，6个月时为-6.76%）和牙槽嵴顶骨吸收（CBL）（3个月时为-0.24 mm，6个月时为-0.28 mm）。
PDT可增强种植体周围疾病治疗中的抗菌效果，联合MD时可显著改善PPD、CBL和BoP。然而，由于证据的总体确定性为中度至低度，且纳入研究中存在一些偏倚风险问题，这些结果应谨慎解读。需要进一步开展高质量、精心设计的随机对照试验来证实这些效果并优化治疗方案。
PROSPERO CRD42021262889。
