Antimicrobial Photodynamic Therapy for the Management of Gingivitis and White Spot Lesions in Fixed Orthodontic Patients: A Systematic Review Publisher Pubmed



Bahrami R¹ ; Pourhajibagher M² ; Gharibpour F¹ Show Affiliations
Source: International Orthodontics Published:2024

Abstract

Aim: We conducted this review to evaluate the safety and efficacy of antimicrobial photodynamic therapy (aPDT) for the management of gingivitis and white spot lesions (WSLs) in fixed orthodontic patients. Methods: The PubMed/MEDLINE, Cochrane Library, Scopus, and Google Scholar databases were searched for randomized controlled trials and clinical trials assessing the clinical effectiveness of aPDT for the management of gingivitis and WSLs in fixed orthodontic patients without time limitation. Primary outcomes were the changes in clinical parameters such as DIAGNOdent, plaque index (PI), bleeding on probing (BOP), and gingival index (GI). Secondary outcomes included measurements of microbial and inflammatory factors, such as cytokine levels (tumor necrosis factor alpha [TNF-α], interleukin-1 beta [IL-1β], and interleukin-6 [IL-6]), and bacterial counts. Results: Our search yielded a total of 12 studies that met the inclusion criteria. Among the 11 studies that evaluated gingivitis, the majority employed a diode laser (670 nm, 150 mW, 22 J/cm2, 60 seconds) as the light source and methylene blue at a concentration of 0.0005% (applied for 3 minutes) as the photosensitizer in a single treatment session. The included studies reported positive effects of aPDT on gingivitis management, with more improvements observed in PI, BOP, and GI following aPDT treatment. Additionally, aPDT was found to reduce the counts of periopathogens such as Porphyromonas gingivalis, as well as inflammatory factors (TNF-α, IL-1β, and IL-6). Two studies demonstrated that aPDT, particularly when administered in multiple sessions, effectively controlled the extent of WSLs during orthodontic treatment and yielded favorable outcomes that persisted for several months after treatment. Conclusion: Based on the available evidence, aPDT appears to be a safe and effective treatment option for managing WSLs and gingivitis in patients with fixed orthodontic appliances. However, further high-quality RCTs are necessary to investigate the impact of potential confounding factors on the efficacy of aPDT. © 2023 CEO