Is the Use of Antimicrobial Photodynamic Therapy or Systemic Antibiotics More Effective in Improving Periodontal Health When Used in Conjunction with Localised Non-Surgical Periodontal Therapy? A Systematic Review

Abstract

Periodontal disease can be treated in several ways. This paper reviewed whether antimicrobial photodynamic therapy (aPDT) in addition to scaling and root planing (SRP) produces improved clinical results over systemic antibiotics (ABs) in conjunction with SRP in adults with periodontitis. Studies were searched using the following electronic databases: MEDLINE, the Cochrane Database of Systematic Reviews, and the Web of Science Core Collection up to and including November 2018. Four randomized controlled trials (RCTs) were reviewed to maximise the reliability of the evidence. All participants suffered from either chronic or aggressive periodontitis and each study contained SRP as an adjunct to ABs or aPDT. To determine whether groups showed improvement after treatment, the outcome parameters chosen were probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). Despite finding significant improvements in all groups, the differences among groups were not consistently statistically significant. The lack of homogeneity in the results among these studies indicates that it was not possible to determine a conclusion about whether aPDT or AB as an adjunct to SRP provides better improvements in periodontitis as measured by PD, CAL, and BOP. Further studies with more similar study designs are required before firm conclusions can be deduced.

Antimicrobial photodynamic therapy compared to systemic antibiotic therapy in non-surgical treatment of periodontitis: Systematic review and meta-analysis

“…Smoking was considered an important risk factor that affects the speed of disease progression, and we decided not to exclude the study with smokers [19], since it makes a direct comparison between the two groups, not mixing smoking and non-smoking patients, and the limited amount of papers present in the literature. Thus, our findings for the comparison of SRP+aPDT with the SRP+AMX+ MTZ for the non-surgical treatment of periodontitis are in agreement with the other two [31,32] similar reviews previously published. Although of the new studies added, of narrowing the comparison with only a combination of antibiotics and pointing out new possibilities of bias in the included studies, we cannot conclude that any of the studied therapies present better or worse results for any of the analyzed clinical parameters.…”

“…Periodontitis is one of the most common inflammatory diseases in humans [28], and AMX+MTZ is the combination of antibiotics most used as an adjunct treatment in non-surgical periodontal treatment [29,30]. Two reviews similar to this one were published previously, in 2017 [31] and 2019 [32], although they did not include recent studies published in 2018 [19], and approved for publication in 2020, with an online version in 2019 [18], in addition to not focusing on the combination of antibiotics studied in this review, giving a possible bias to the results that could be attributed to the type of antibiotic used instead of analyzing the effectiveness of antibiotic treatment as a better or worse adjunctive therapy than aPDT for periodontitis. Teugheus, et al [13] in a recent systematic review showed that the association of AMX+MTZ in the adjunctive treatment of periodontitis had the best clinical periodontal improvements when compared to amoxicillin and metronidazole used alone, azithromycin, clarithromycin and moxifloxacin.…”

“…Four [19,20,21,22] of the five included studies did not mention any oral hygiene technique or instruction performed prior to the mechanical treatment of periodontitis, which may have added bias to the analyzed results. Oral hygiene instructions are of fundamental importance for any periodontal treatment, influencing the removal of plaque and calculus by the patient, which can affect bacterial recolonization after treatment and compromise the clinical success of therapy [32].…”

Clindamycin as an Alternative Option in Optimizing Periodontal Therapy

“…A 2019 systematic review analyzed whether SRP plus antimicrobial photodynamic therapy exerted an improved clinical outcome in comparison to SRP plus systemic antibiotics in periodontal disease. Although there were significant improvements for both treatment modalities, the inter-group discrepancy was not statistically significant in a consistent manner, and further studies are necessary in order to state a definite conclusion [58].…”

Photodynamic Therapy for Peri-Implant Diseases

“…Regarding periodontitis, if the use of antibiotics as an adjunct needs justification, Maan et al [ 123 ] in their systematic review concluded that better clinical outcomes are observed, supported by another systematic review and meta-analysis by Zhao et al [ 124 ], who compared systemic antibiotics and PDT as adjuncts in periodontitis and peri-implantitis. Another review [ 125 ] contradicts such observations by stating that both systemic antibiotics and PDT as adjuncts in periodontitis (it did not include peri-implantitis) were not convincing in obtaining clinical improvements in probing depths, clinical attachment levels and bleeding on probing. The systematic review by Øen et al in 2021 [ 126 ] opined that adjunctive systemic antibiotics cannot be considered as standard treatment in peri-implantitis.…”