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Does aPDT reduce bacterial load in endodontic infected teeth? A systematic review and meta-analysis.Lasers in Medical Science Nov 2023This systematic review investigated whether antimicrobial photodynamic therapy (aPDT) after chemomechanical root canal disinfection (CD) yields a greater microbial load... (Meta-Analysis)
Meta-Analysis Review
This systematic review investigated whether antimicrobial photodynamic therapy (aPDT) after chemomechanical root canal disinfection (CD) yields a greater microbial load reduction than only CD. An electronic literature search was conducted on four databases up to November 2022, with no language or publication date restrictions. Randomized and non-randomized clinical trials were included if participants had a primary endodontic infection in permanent teeth, and if microbial loads before and after using aPDT were compared. Two researchers independently screened titles and abstracts to determine study eligibility. Assessments included risk of bias and methodological quality. This review was registered in PROSPERO (CRD42020181783). Eight studies were included in the qualitative analysis, and six were eligible for meta-analysis. In the random effects model, aPDT significantly improved the results of root canal disinfection when compared with standard protocols for cleaning and shaping (p = 0.04, 95% CI -1.72, -0.05). Subgroup analysis suggested that aPDT has a better effect on reducing the load of anaerobic microorganisms (p = 0.003, 95% CI -3.36, -0.69). The use of aPDT as an adjunct to chemomechanical disinfection promotes additional reduction of the microbial load and, therefore, seems to improve the results of root canal treatments in permanent teeth with a primary endodontic infection. However, certainty of evidence should be improved.
Topics: Humans; Bacterial Load; Anti-Infective Agents; Disinfection; Photochemotherapy; Root Canal Therapy
PubMed: 37981598
DOI: 10.1007/s10103-023-03938-4 -
Graefe's Archive For Clinical and... Jun 2024Corneal collagen crosslinking (CXL) is the primary treatment for progressive keratoconus which has a significant impact on vision and quality of life. Our study aimed to... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Corneal collagen crosslinking (CXL) is the primary treatment for progressive keratoconus which has a significant impact on vision and quality of life. Our study aimed to compare the efficacy and safety of epithelium-on versus epithelium-off CXL to treat keratoconus.
METHODS
We searched PubMed, Medline, Embase, Web of Science, and Scopus databases. We included studies that compared standard epithelium-off with epithelium-on CXL. The primary outcome measures were changes in corrected distance visual acuity (CDVA) and maximum keratometry (Kmax), and the secondary outcomes were uncorrected distance visual acuity (UDVA), central corneal thickness (CCT), and adverse events. A meta-analysis was performed on the primary and secondary outcomes based on the weighted mean differences between baseline to 12-month follow-up.
RESULTS
The search retrieved 887 publications with 27 included in the systematic review. A total of 1622 eyes (1399 patients; age 25.51 ± 4.02 years) were included in comparisons of epithelium-off to epithelium-on CXL in keratoconus. Epithelium-off CXL treated 800 eyes and epithelium-on CXL for 822 eyes. At 12-month follow-up, CDVA and Kmax showed no significant difference between the epithelium-off and epithelium-on CXL. The secondary outcomes showed that UDVA was better in epithelium-off CXL (- 0.11D, 95% CI - 0.12, - 0.1; p < 0.001) and there was more thinning in CCT in epithelium-off CXL (- 3.23 μm, 95% CI - 4.64, - 1.81; p <0.001).
CONCLUSION
Epithelium-off and epithelium-on CXL were both effective to treat progressive keratoconus. Further research is needed to compare the long-term outcomes and safety of both CXL protocols for adaptation into clinical practice.
Topics: Keratoconus; Humans; Cross-Linking Reagents; Collagen; Photosensitizing Agents; Epithelium, Corneal; Photochemotherapy; Visual Acuity; Riboflavin; Ultraviolet Rays; Corneal Topography; Corneal Stroma
PubMed: 37938377
DOI: 10.1007/s00417-023-06287-8 -
BMC Oral Health Oct 2023To evaluate the clinical efficacy of photodynamic therapy (PDT) as an adjunct or alternative to traditional antifungal drugs in the treatment of oral candidiasis, and to... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the clinical efficacy of photodynamic therapy (PDT) as an adjunct or alternative to traditional antifungal drugs in the treatment of oral candidiasis, and to provide evidence-based medical evidence for its use in the treatment of oral candidiasis.
METHODS
Computer combined with manual retrieval of China Academic Journals Full-text Database (CNKI), China Biomedical Literature Database (CBM), Chinese Science and Technology Journal Database (VIP), Wanfang Database, PubMed, Web of Science, Cochrane Library, Embase, Scopus retrieval for articles published before January 2023, basic information and required data were extracted according to the inclusion and exclusion criteria, and the Revman V5.4 software was used to conduct Meta-analysis of the included literature.
RESULTS
A total of 11 articles were included, 7 of which used nystatin as an antifungal drug, 2 of which were combined treatment of PDT and nystatin, 2 of the remaining 4 articles were treated with fluconazole, and 2 were treated with miconazole. Meta results showed that PDT was superior to nystatin in reducing the number of oral candida colonies in the palate of patients MD = -0.87, 95%CI = (-1.52,-0.23), P = 0.008, the difference was statistically significant, and the denture site MD = -1.03, 95%CI = (-2.21, -0.15), P = 0.09, the difference was not statistically significant; compared with the efficacy of fluconazole, RR = 1.01, 95%CI = (0.56,1.83), P = 0.96; compared with miconazole RR = 0.55, 95%CI = (0.38, 0.81), P = 0.002; PDT combined with nystatin RR = 1.27, 95%CI = (1.06, 1.52), P = 0.01; recurrence rate RR = 0.28, 95%CI = (0.09, 0.88), P = 0.03.
CONCLUSIONS
PDT was effective in the treatment of oral candidiasis; PDT was more effective than nystatin for the treatment of denture stomatitis in the palate, while there was no significant difference between the two for the denture site; The efficacy of PDT for oral candidiasis was similar to that of fluconazole; PDT was less effective than miconazole for oral candidiasis; Compared with nystatin alone, the combination of PDT and nystatin is more effective in treating oral candidiasis with less risk of recurrence.
Topics: Humans; Candidiasis, Oral; Antifungal Agents; Nystatin; Fluconazole; Miconazole; Photochemotherapy
PubMed: 37884914
DOI: 10.1186/s12903-023-03484-z -
BMC Oral Health Oct 2023Type 2 diabetes mellitus (T2DM) is a major risk factor for localized diseases such as peri-implantitis that may affect ideal implant treatment. This study was aimed to... (Meta-Analysis)
Meta-Analysis
Evaluating the effect of mechanical debridement with adjunctive antimicrobial photodynamic therapy in comparison with mechanical debridement alone on the peri-implant parameters in type 2 diabetic mellitus patients with peri-implantitis: a systematic review and meta-analysis.
BACKGROUND
Type 2 diabetes mellitus (T2DM) is a major risk factor for localized diseases such as peri-implantitis that may affect ideal implant treatment. This study was aimed to evaluate the effect of mechanical debridement (MD) + antimicrobial photodynamic therapy (a-PDT) in patients with peri-implantitis who have T2DM in terms of bleeding on probing (BOP) and probing depth (PD) as primary outcomes and plaque index (PI) and crestal bone loss (CBL) as secondary outcomes.
METHODS
Publications compared outcomes between MD + aPDT and MD alone in T2DM patients with peri-implantitis, containing more than 3-month follow-up duration, were involved in the systematic review and meta-analysis. Literature until July 2023 using MEDLINE (through PubMed), Scopus, Cochrane Library, Embase, Web of Science, and Google Scholar were collected.
RESULTS
Two randomized controlled trials (RCTs, 88 individuals) and one controlled clinical trial (CCT, 67 individuals) with follow-up periods ranged from 3 to 12 months were recruited. All studies used diode laser with wavelengths ranged from 660 to 810 nm. The results demonstrated that the MD + aPDT group showed significant benefits for BOP reduction after 6 months (SMD = -2.15, 95% CI: -3.78 to -0.51, p = 0.01). However, a great amount of heterogeneity was observed (I = 91.52%, p < 0.001). Moreover, there was a significant difference between MD + aPDT and MD alone groups in CBL (SMD = -0.69, 95% CI: -1.07 to -0.30, p < 0.001). In addition, homogeneity assumption was satisfied (I = 22.49%, p = 0.28). Significant differences in PD and PI reduction were not found except for PI reduction after 3 months (SMD = -0.79, 95% CI: -1.24 to -0.33, p < 0.001. Also, no heterogeneity was observed (I = 0.00%, p = 0.47).
CONCLUSION
Given that high heterogeneity in BOP and PD outcome was found in this systematic review, future long-term CTs with MD + aPDT should be examined to arrive at a firm conclusion.
Topics: Humans; Peri-Implantitis; Debridement; Diabetes Mellitus, Type 2; Dental Implants; Photochemotherapy; Anti-Infective Agents
PubMed: 37828479
DOI: 10.1186/s12903-023-03337-9 -
International Journal of Dental Hygiene Feb 2024To systematically evaluate randomised controlled trials (RCTs) on whether adjuvant application of antimicrobial photodynamic therapy (aPDT) through the technique of... (Review)
Review
OBJECTIVES
To systematically evaluate randomised controlled trials (RCTs) on whether adjuvant application of antimicrobial photodynamic therapy (aPDT) through the technique of irradiation in the external region of the periodontal pocket with optic-fibre tip offers benefits to scaling and root planning (SRP).
METHODS
Five databases were searched by two independent reviewers according to pre-specified eligibility criteria up to April 2023. No restrictions regarding date of publication, language and minimum follow-up period were imposed. The Cochrane Collaboration's Risk of Bias tool (RoB 2.0) was used for quality appraisal and Grading of Recommendations, Assessment, Development and Evaluation for assessing the certainty of evidence.
RESULTS
A total of 1388 publications were identified and reviewed for eligibility. Four of them fulfilled the inclusion criteria. The sample consisted of a total of 83 patients with periodontitis. In these, 330 periodontal sites were evaluated. The clinical findings of the majority of the included studies demonstrated that patients who received the association of aPDT + RAR with the protocol evaluated here, obtained clinical results similar to patients who received only the SRP alone. In none of the evaluated RCTs, clinical advantages were observed that would categorise this aPDT protocol as superior to conventional treatment.
CONCLUSION
Applying aPDT after SRP with external irradiation of the periodontal pocket does not seem to result in any clinical benefit compared to the use of SRP alone in patients with periodontitis.
Topics: Humans; Periodontal Pocket; Root Planing; Randomized Controlled Trials as Topic; Photochemotherapy; Dental Scaling; Periodontitis; Combined Modality Therapy; Anti-Infective Agents; Chronic Periodontitis
PubMed: 37752814
DOI: 10.1111/idh.12759 -
Photodiagnosis and Photodynamic Therapy Dec 2023Pseudomonas aeruginosa is a Gram-negative bacillus that causes superficial and deep infections, which can be minor to life-threatening. Recently, P. aeruginosa has... (Review)
Review
BACKGROUND
Pseudomonas aeruginosa is a Gram-negative bacillus that causes superficial and deep infections, which can be minor to life-threatening. Recently, P. aeruginosa has gained significant relevance due to the increased incidence of multidrug-resistant (MDR) strains that complicate antibiotic treatment. Due to MDR strains, alternative therapies, such as antimicrobial photodynamic therapy (PDT), are presented as a good option to treat nonsystemic infections. PDT combines a photosensitizer agent (PS), light, and oxygen to generate free radicals that destroy bacterial structures such as the envelope, matrix, and genetic material. This work aimed to identify the development stage of the PDT applied to P. aeruginosa to conclude which research stage should be emphasized more.
METHODS
Systematic bibliographic search in various public databases was performed. Related articles were identified using keywords, and relevant ones were selected using inclusion and exclusion criteria according to the PRISMA protocol.
RESULTS
We found 29 articles that meet the criteria, constituting a good body of evidence associated with using PDT against P. aeruginosa in vitro and less developed for in vivo research.
CONCLUSIONS
We conclude that PDT could become an effective adjunct to antimicrobial therapy against P. aeruginosa. This effectiveness depends on the PS used and the location of the infection. Many PS already demonstrated efficacy in PDT, but the evidence is supported significantly by in vitro and very few in vivo studies. Therefore, we conclude that further research efforts should focus on demonstrating the safety and efficacy of these PSs in vivo in animal infection models.
Topics: Animals; Pseudomonas Infections; Photosensitizing Agents; Photochemotherapy; Anti-Bacterial Agents; Gram-Negative Bacteria; Pseudomonas aeruginosa
PubMed: 37709240
DOI: 10.1016/j.pdpdt.2023.103803 -
Lasers in Medical Science Sep 2023Despite their high success rates, peri-implantitis can affect the stability and function of dental implants. Various treatment modalities have been investigated for the...
Despite their high success rates, peri-implantitis can affect the stability and function of dental implants. Various treatment modalities have been investigated for the treatment of peri-implantitis to achieve re-osseointegration. An electronic literature search was performed supplemented by a manual search to identify studies published until January 2022. Articles that evaluated re-osseointegration in peri-implantitis sites in animal models following laser therapy or antimicrobial photodynamic therapy (aPDT) were included. Case reports, case series, systematic reviews, and letters to the editor were excluded. Risk of bias and GRADE assessment were followed to evaluate the quality of the evidence. Six studies out of 26 articles identified on electronic search were included in this review. The studies included animal studies conducted on canine models. Four out of six studies reported a higher degree of re-osseointegration following treatment of implants with laser therapy. The findings suggest that laser decontamination shows potential in enhancing re-osseointegration, particularly with the Er: YAG laser, which effectively decontaminated implant surfaces. However, conflicting outcomes and limitations in the evidence quality warrant caution in drawing definitive conclusions. Based on the limited available evidence, laser therapy may show a higher degree of re-osseointegration of implants than mechanical debridement.
Topics: Animals; Dental Implants; Lasers; Osseointegration; Peri-Implantitis; Photochemotherapy
PubMed: 37658921
DOI: 10.1007/s10103-023-03860-9 -
Photodiagnosis and Photodynamic Therapy Dec 2023Objective To investigate the effect of low-level laser and photodynamic therapy on the oral health, and periodontal tissue of fixed orthodontic patients and the effect... (Meta-Analysis)
Meta-Analysis
Objective To investigate the effect of low-level laser and photodynamic therapy on the oral health, and periodontal tissue of fixed orthodontic patients and the effect of using photobiomodulation methods compared to routine plaque removal methods and the amount of plaque in fixed orthodontic patients. Method and materials First, the title and summary of related articles were collected by using the search strategy electronic databases PUBMED, EMBASE, Cochrane's CENTRAL, Scopus, ISI and all the articles that were published from the beginning to February 2023 were evaluated. The title, abstracts and full texts of all the relevant studies were reviewed respectively, and those meeting the criteria were entered into our study. Finally, the quality of the studies was examined and the results of the studies were pooled by means of random effects inverse variance meta-analysis. Results Eighteen randomized studies, conducted between 2015 and December 2022, were selected for meta-analysis. Five studies were conducted as split-mouth, twelve as parallel-group, and one as a cross-over design. Among the studies, five examined the effects of low-level laser therapy and twelve assessed the effects of photodynamic therapy. The meta-analysis revealed that photodynamic therapy significantly reduced probing depth compared to scaling (MD=-0.2 mm, P<0.001), though the difference does not seem to be clinically significant. But no significant differences between photodynamic therapy and scaling or low-level laser therapy and control groups in terms of plaque index, or bleeding on probing, gingival crevicular fluid volume, gingival recession, clinical attachment loss, bacterial load and concentrations of inflammatory substances across multiple follow-up periods. Conclusion Moderate evidence indicates that photodynamic therapy (PDT) is comparable to conventional methods in improving oral health, as measured by periodontal indices, inflammatory proteins, bacterial colonies, and white spot lesions, making it a suitable alternative. Limited evidence suggests low-level laser therapy (LLLT) may improve oral health, particularly addressing caries, but further research is needed.
Topics: Humans; Photochemotherapy; Low-Level Light Therapy; Oral Health; Photosensitizing Agents; Orthodontics; Dental Scaling
PubMed: 37604216
DOI: 10.1016/j.pdpdt.2023.103759 -
BMC Oral Health Aug 2023This study aims to evaluate the efficacy of photodynamic therapy (PDT) in the treatment of oral leukoplakia and explore the subgroup factors that may influence its... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study aims to evaluate the efficacy of photodynamic therapy (PDT) in the treatment of oral leukoplakia and explore the subgroup factors that may influence its effectiveness.
METHODS
A systematic search was conducted in PubMed, Embase, the Cochrane Library, and Web of Science databases to identify relevant studies. Meta-analysis was performed using Stata15.0 software. Cochran's Q test and I statistics were used to evaluate heterogeneity, egger's test was used to evaluate publication bias.
RESULTS
The analysis of 17 studies included in this study suggests that PDT may be effective in achieving complete response (CR) [ES = 0.50, 95%CI: (0.33,0.66)], partial response (PR) [ES = 0.42, 95%CI: (0.27,0.56)], no response (NR) [ES = 0.19, 95%CI: (0.11,0.27)]in patients with oral leukoplakia. The recurrence rate was also evaluated [ES = 0.13, 95%CI: (0.08,0.18)]. Subgroup analysis showed that various factors such as light source, wavelength, medium, duration of application, clinical and pathological diagnosis classification influenced efficacy of PDT. The lesion areas of the leukoplakia after treatment were reduced by 1.97cm compared with those before treatment.
CONCLUSION
Our findings show that PDT is a viable treatment for oral leukoplakia. However, the effectiveness of the therapy may depend on several factors, as suggested by our subgroup analyses. (Registration no. CRD42023399848 in Prospero, 26/02/2023).
Topics: Humans; Photosensitizing Agents; Photochemotherapy; Leukoplakia, Oral
PubMed: 37574560
DOI: 10.1186/s12903-023-03294-3 -
Photodiagnosis and Photodynamic Therapy Dec 2023Photodynamic therapy (PDT) has emerged as an effective therapy for various dermatology conditions, including oral lichen planus (OLP). The objective of this study was to... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Photodynamic therapy (PDT) has emerged as an effective therapy for various dermatology conditions, including oral lichen planus (OLP). The objective of this study was to evaluate the efficacy of PDT in managing OLP and to compare its effectiveness with corticosteroid therapy (CST).
MATERIALS AND METHODS
A comprehensive electronic search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilizing databases such as PubMed, Embase, Google Scholar, Semantic Scholar, X-mole, and Dimensions. The inclusion criteria encompassed randomized controlled clinical trials (RCTs) that included patients with OLP undergoing treatment with PDT and CST, with no limitations on sample size or patient age.
RESULTS
Out of 197 studies identified, only 8 met the inclusion criteria, involving 210 patients (104 in Group I: PDT, 106 in Group II: CST), with a female to male ratio of 3.75. Three studies reported OLP lesion numbers, six studies described lesion types, and five studies provided lesion location information. The efficacy of both PDT and CST was assessed using lesion size, pain, Thongprasom sign (ThS) scoring, efficacy index (EI), and clinical severity index (CSI). The limited and inconsistent reporting of data hindered to conduct a meta-analysis.
CONCLUSIONS
PDT effectively treats OLP lesions, leading to significant symptom reduction and improved functionality. However, limited relevant RCTs and heterogeneous data reporting hinder definitive conclusions regarding the efficacy of PDT compared to CTS.
Topics: Male; Female; Humans; Photochemotherapy; Photosensitizing Agents; Lichen Planus, Oral; Randomized Controlled Trials as Topic; Adrenal Cortex Hormones
PubMed: 37567329
DOI: 10.1016/j.pdpdt.2023.103747