Oliveira Higor Henrique Carvalho, Chicrala-Toyoshima Gabriela Moura, Damante Carla Andreotti, Ferreira Rafael
Faculdade de Odontologia, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil.
Discipline of Stomatology, Faculdade de Odontologia, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil.
Dent J (Basel). 2025 Jun 26;13(7):289. doi: 10.3390/dj13070289.
The adjunctive use of antimicrobial photodynamic therapy (aPDT) has been investigated as a promising approach to enhance periodontal therapy. Methylene blue (MB) is the most commonly used photosensitizer due to its favorable characteristics, including a neutral pH and an absorption peak at 660 nm. Due to the considerable heterogeneity among studies and the lack of well-established clinical protocols, this study aims to conduct an integrative review to highlight the effects of MB-mediated aPDT as an adjunct to periodontal treatment. The inclusion criteria were randomized clinical trials that used MB as the PS, published between 2009 and 2024, with a minimum follow-up of three months. Studies included patients with periodontitis treated with SRP alone or in combination with aPDT. Of the 237 studies initially identified, 23 met the eligibility criteria and were included in this integrative review. The risk of bias was evaluated using the Cochrane criteria for randomized controlled trials. Although the included studies reported heterogeneous clinical outcomes, a general trend toward improvement in key periodontal parameters-probing depth, bleeding on probing, clinical attachment level, and plaque index-was observed when MB-mediated aPDT was used as an adjunct to conventional periodontal treatment. However, substantial variability in clinical protocols-including differences in photosensitizer concentration, type of light source, irradiation time, and frequency of application-limited the comparability of results across studies. Despite these methodological inconsistencies, current evidence suggests that MB-mediated aPDT holds promise as an adjunctive approach in periodontal therapy. Nevertheless, due to the clinical heterogeneity and the limited number of studies with long-term follow-up, its overall efficacy remains inconclusive. Further well-designed randomized controlled trials with standardized protocols and subgroup analyses are essential to validate its clinical relevance.
抗菌光动力疗法（aPDT）的辅助应用已被研究作为一种增强牙周治疗的有前景的方法。亚甲蓝（MB）因其有利特性，包括中性pH值和660nm的吸收峰，是最常用的光敏剂。由于研究之间存在相当大的异质性且缺乏成熟的临床方案，本研究旨在进行一项综合综述，以突出MB介导的aPDT作为牙周治疗辅助手段的效果。纳入标准为2009年至2024年期间发表的、以MB作为光敏剂的随机临床试验，最短随访期为三个月。研究纳入了单独接受龈上洁治术（SRP）或联合aPDT治疗的牙周炎患者。在最初确定的237项研究中，23项符合纳入标准并被纳入本综合综述。使用Cochrane随机对照试验标准评估偏倚风险。尽管纳入的研究报告了异质的临床结果，但当MB介导的aPDT作为传统牙周治疗的辅助手段时，观察到关键牙周参数——探诊深度、探诊出血、临床附着水平和菌斑指数——有总体改善趋势。然而，临床方案存在很大差异，包括光敏剂浓度、光源类型、照射时间和应用频率的差异，限制了各研究结果的可比性。尽管存在这些方法上的不一致，但目前的证据表明，MB介导的aPDT作为牙周治疗的辅助方法有前景。然而，由于临床异质性和长期随访研究数量有限，其总体疗效仍不确定。进一步设计良好的、具有标准化方案和亚组分析的随机对照试验对于验证其临床相关性至关重要。
