Clinical effectiveness of adjunctive antimicrobial photodynamic therapy for residual pockets during supportive periodontal therapy: A systematic review and meta-analysis.
PURPOSE
To evaluate the clinical efficacy of antimicrobial photodynamic therapy (aPDT) adjunctive to scaling and root planing (SRP) in the treatment of residual pockets for chronic periodontitis patients on supportive periodontal therapy (SPT).


METHOD
Bibliographic databases of MEDLINE and Cochrane Library were thoroughly searched up to July 2016 for eligible randomized controlled trials (RCTs). Mean differences (MD) and the corresponding 95% confidence intervals (CI) were synthesized for probing depth (PD) reduction and clinical attachment level (CAL) gain. The I2 test and Q statistics were employed to assess inter-study heterogeneity. Subgroup analysis was performed based on the enrollment of smokers.


RESULT
Four RCTs fulfilling the eligibility criteria were included. Pooled estimates demonstrated statistically significant improvements in both PD reduction (MD=0.69, CI: 0.11-1.28, p=0.02) and CAL gain (MD=0.60, CI: 0.11-1.10, p=0.02) for SRP+aPDT versus SRP alone. Meta-analysis of studies with smokers failed to produce a significant additional effect in PD (MD=0.32, CI: -0.30 to 0.94, p=0.31) and CAL (MD=0.42, CI: -0.26 to 1.09, p=0.23) when SRP was associated with aPDT. However, significant enhancements in PD reduction (MD=1.23, CI: 0.74-1.72, p<0.001) and CAL gain (MD=0.96, CI: 0.31-1.62, p=0.004) were observed for studies excluding smokers.


CONCLUSION
Pooled evidence indicates an additional clinical improvement in the maintenance of residual pockets in favor of SRP+aPDT compared with SRP alone. Subgroup analysis demonstrates an adverse impact of smoking on clinical effect of the combined therapy. Substantial heterogeneity and the paucity of included studies undermine the statistical power of this meta-analysis. Future well-designed and large-scale clinical trials evaluating the adjunctive efficacy of aPDT in periodontal maintenance phase are critically needed.
['Xue|Dong|D|', 'Zhao|Ying|Y|']
D000328:Adult D055113:Chronic Periodontitis D003131:Combined Modality Therapy D012534:Dental Scaling D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D010778:Photochemotherapy D016032:Randomized Controlled Trials as Topic D016745:Root Planing
Antimicrobial photodynamic therapy Residual pockets Supportive periodontal therapy Meta-analysis Scaling and root planing Chronic periodontitis