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Background <p>Scaling and root planing (SRP) is widely accepted as the gold-standard nonsurgical therapy for periodontitis. However, anatomical limitations, persistent biofilms, and host-related factors often restrict the clinical response. Antimicrobial photodynamic therapy (aPDT), which combines a photosensitizer activated by low-level laser or LED irradiation, has emerged as a targeted antimicrobial approach that avoids antibiotic resistance and preserves surrounding tissues.</p> Objective <p>This systematic review aimed to determine whether adjunctive aPDT provides additional clinical benefits when combined with SRP in patients with chronic or aggressive periodontitis.</p> Methods <p>A comprehensive search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted up to December 2025. Only randomized controlled trials (RCTs) comparing SRP + aPDT with SRP alone or SRP + placebo in adults were included. Primary outcomes were probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain at ≥ 3 months. Risk of bias was assessed using the Cochrane RoB 2 tool, and certainty of evidence was evaluated using GRADE. Methylene blue and indocyanine green were the most frequently used photosensitizers.</p> Results <p>Twenty-six RCTs involving 1,132 participants met the inclusion criteria. Pooled analyses across randomized trials indicated modest additional improvements in PPD and CAL when aPDT was used adjunctively. Enhanced effects were frequently reported in smokers, patients with diabetes, and sites with ≥ 6-mm residual pockets, particularly when multiple aPDT sessions were delivered. No serious adverse events were reported.</p> Conclusion <p>Adjunctive antimicrobial photodynamic therapy may offer modest additional clinical benefits when combined with scaling and root planing, particularly in selected patients with deep periodontal pockets or systemic risk factors. However, heterogeneity in study design and treatment protocols limits definitive clinical recommendations, highlighting the need for further well-designed randomized controlled trials.</p>

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Effect of using antimicrobial photodynamic therapy as an adjunct to periodontal treatment: a systematic review of randomized controlled trials

  • 期刊论文

  • 发表日期：

    2026年2月4日

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  • Nahid Derikvand,
  • Seyed Amir Hossein Ghasemi,
  • Hiva Ebrahimi,
  • Seyedeh Sara Ghasemi

摘要

Background

Scaling and root planing (SRP) is widely accepted as the gold-standard nonsurgical therapy for periodontitis. However, anatomical limitations, persistent biofilms, and host-related factors often restrict the clinical response. Antimicrobial photodynamic therapy (aPDT), which combines a photosensitizer activated by low-level laser or LED irradiation, has emerged as a targeted antimicrobial approach that avoids antibiotic resistance and preserves surrounding tissues.

Objective

This systematic review aimed to determine whether adjunctive aPDT provides additional clinical benefits when combined with SRP in patients with chronic or aggressive periodontitis.

Methods

A comprehensive search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted up to December 2025. Only randomized controlled trials (RCTs) comparing SRP + aPDT with SRP alone or SRP + placebo in adults were included. Primary outcomes were probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain at ≥ 3 months. Risk of bias was assessed using the Cochrane RoB 2 tool, and certainty of evidence was evaluated using GRADE. Methylene blue and indocyanine green were the most frequently used photosensitizers.

Results

Twenty-six RCTs involving 1,132 participants met the inclusion criteria. Pooled analyses across randomized trials indicated modest additional improvements in PPD and CAL when aPDT was used adjunctively. Enhanced effects were frequently reported in smokers, patients with diabetes, and sites with ≥ 6-mm residual pockets, particularly when multiple aPDT sessions were delivered. No serious adverse events were reported.

Conclusion

Adjunctive antimicrobial photodynamic therapy may offer modest additional clinical benefits when combined with scaling and root planing, particularly in selected patients with deep periodontal pockets or systemic risk factors. However, heterogeneity in study design and treatment protocols limits definitive clinical recommendations, highlighting the need for further well-designed randomized controlled trials.