Photodynamic Therapy and Peri-implant Diseases: A Systematic Review and Metaanalysis

Yumeng Yan¹Roberto Rotundo²Jeanie Suvan³Marco Orlandi¹Alessandro Poma⁴Francesco D'Aiuto^1*

• ¹Periodontology Unit, UCL Eastman Dental Institute, london, United Kingdom
• ²Università Vita-Salute San Raffaele, Milano, Italy, milan, Italy
• ³Oral Sciences, University of Glasgow Dental School, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow UK, Glasgow, United Kingdom
• ⁴Biomaterials and Tissue Engineering, UCL Eastman Dental Institute, London, UK, london, United Kingdom

Aim: 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 to mechanical debridement alone.Methods: 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 15th June 2024. Only randomized 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 randomized controlled trials were 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.Results: A total of 26 studies were included in this study. 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 to 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).Conclusion: 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 randomized controlled trials are warranted to confirm these effects and optimize treatment protocols.