Efficacy of photodynamic therapy versus antibiotics as an adjunct to scaling and root planing in the treatment of periodontitis: A systematic review and meta-analysis

Background: To determine whether treatment with antimicrobial photodynamic therapy (aPDT) as an adjunct to scaling and root planing (SRP) yield better clinical periodontal outcomes than antibiotics (AB) as adjunct to SRP in periodontitis. Methods: Electronic searches were conducted in databases (MEDLINE, PubMed, EMBASE, SCOPUS, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) up to and including April 2017. Results: Five randomized trials were included. All studies used the combined approach aPDT + SRP and AB + SRP in the test and control group respectively. The follow up period ranged from 12 to 48 weeks. All studies used diode lasers. The wavelengths, power density and duration of irradiation used were 670 nanometre, 75 milliwatts per square centimeters and 60 s respectively. None of the studies showed additional benefits of aPDT at follow up. Considering the effects of adjunctive aPDT as compared to AB, a high degree of heterogeneity for periodontal probing depth (PPD) (p < 0.0001,I-2 = 87.47%) was noticed among both the groups. Meta-analysis showed significant clinical attachment level (CAL) gain (WMD = 0.60, 95% CI = 0.25 to 0.95, p = 0.001), and not PPD reduction (WMD = 0.67, 95% CI = 0.36 to 1.71, p = 0.204) for aPDT as compared to AB at follow up. Conclusion: It remains debatable whether aPDT is more effective as compared to adjunctive AB in the treatment of periodontitis, given that the scientific evidence is weak. Precautions must be exercised when interpreting the results of this study due to the small sample size and high heterogeneity among studies.