Indocyanine green–mediated antimicrobial photodynamic therapy as an adjunct to periodontal therapy: a systematic review and meta-analysis

Abstract

Objectives The aim of this systematic review and meta-analysis was to evaluate the efficacy of indocyanine green–mediated photodynamic therapy (ICG-PDT) as an adjunct to non-surgical periodontal therapy (NSPT), in the management of chronic periodontitis. Materials and methods Four electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Embase via OVID, Web of Science) were searched for randomised controlled trials comparing NSPT with ICG-PDT to NSPT without laser therapy. Primary outcome measures were changes in probing pocket depth (PPD) and clinical attachment level (CAL). Clinical outcomes were extracted and pooled from 7 eligible trials and meta-analyses conducted using mean difference with standard deviations. Results For PPD, adjunctive ICG-PDT resulted in a mean additional reduction of 1.17 mm (95% CI: 0.67–1.66 mm) at 3 months and a mean additional reduction of 1.06 mm (95% CI: 0.54–1.57 mm) at 6 months. For CAL, adjunctive ICG-PDT resulted in a mean additional gain of 0.70 mm (95% CI: 0.17–1.23 mm) at 3 months and a mean additional gain of 1.03 mm (95% CI: 0.83–1.24 mm) at 6 months. No adverse events were reported in any studies. Conclusions The adjunctive use of ICG-PDT in NSPT results in improved treatment outcomes at 3 and 6 months post-therapy. Further investigation is needed to evaluate variables such as different photosensitiser concentrations and adjusting parameters associated with the light source. Clinical relevance Indocyanine green–based photosensitisers may be a novel, clinically efficacious agent for use in the management of periodontitis.

The Effects of 810 nm Diode Laser and Indocyanine Green on Periodontal Parameters and HbA1c in Patients with Periodontitis and Type II Diabetes Mellitus: A Randomized Controlled Study

“…Existing data in the literature on the effectiveness of aPDT with various photosensitizers are heterogeneous. While some results suggest that the benefits of SRP supplementation with aPDT are minor [ 29 ], other information, focused on the effects of aPDT with indocyanine green, would indicate that indocyanine green is more effective than previously analyzed agents in the management of periodontitis [ 30 ]. Although the local effects of using methylene blue or toluidine have been beneficial in terms of periodontal status improvements in patients with DM, they may generate a number of less desirable effects, such as tooth staining due to their prolonged adhesive property [ 31 ].…”

“…Mechanisms that could explain the beneficial effects of indocyanine green as an adjunct to aPDT have been investigated in clinical, microbiological, and immunological studies [ 27 , 28 ]. The hypotheses investigated include the bactericidal effect on periodontal pathogens, as well as potential effects on the local immune response [ 30 ].…”

Flapless application of enamel matrix derivative in non‐surgical periodontal treatment: A systematic review

“…Therefore, it becomes crucial to eliminate the risk of residual deep pockets and to avoid the need of additional surgery following the first phase of periodontal treatment by adjunctive measures. Various adjuncts to non‐surgical periodontal treatment have been utilized such as antibiotics, 44 laser, 45 antimicrobial photodynamic therapy, 46 chlorhexidine chip, 47 systemic administration of sub‐antimicrobial dose doxycycline, 48 hyaluronic acid, 49 green tea 50 and probiotics 51 . Although a number of adjuncts to non‐surgical treatments have shown beneficial clinical outcomes, periodontal tissue repair is solely observed following their use 44–51 .…”

“…Various adjuncts to non‐surgical periodontal treatment have been utilized such as antibiotics, 44 laser, 45 antimicrobial photodynamic therapy, 46 chlorhexidine chip, 47 systemic administration of sub‐antimicrobial dose doxycycline, 48 hyaluronic acid, 49 green tea 50 and probiotics 51 . Although a number of adjuncts to non‐surgical treatments have shown beneficial clinical outcomes, periodontal tissue repair is solely observed following their use 44–51 . Due to the regenerative potential of EMD, 7 its use in conjunction with non‐surgical periodontal treatment may result in superior results with minimal patient's morbidity and side effects.…”

The Potential Application of Natural Photosensitizers Used in Antimicrobial Photodynamic Therapy against Oral Infections

“…Non-surgical mechanical debridement is still an optional treatment in patients with periodontitis, although in cases where there is severe periodontitis surgical intervention and the use of systemic antibiotics are usually indicated [56]. The use of effective adjunctive therapies such as APDT could be considered to improve the outcomes of nonsurgical periodontal treatment [57]. In one study, blue LED irradiation (450-470 nm, output power density 1.2 W/cm 2 ) at 6, 12, and 18 J/cm 2 alone reduced the number of CFU/mL of both P. gingivalis and A. actinomycetemcomitans, but this reduction did not reach statistical significance.…”