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SANZ et al .
Background
R2.5 | Are treatment outcomes with adjunctive antimicrobial photodynamic therapy (aPDT) superior to non-surgical subgingival instrumentation alone? Evidence-based recommendation (2.5) We suggest not to use adjunctive a PDT at wavelength ranges of either 660–670 nm or 800–900 nm in patients with periodontitis. Supporting literature Salvi et al. (2019) Quality of evidence Five RCTs ( n = 121, wavelength range 660– 670 nm and wavelength range 800–900 nm) with single aPDT application reporting 6-month outcomes. Three RCTs reported mean PPD changes. Grade of recommendation Grade B—↓ Strength of consensus Consensus (1.3% of the group abstained due to potential CoI)
Intervention Lasers offer the potential to improve outcomes of subgingi - val root surface treatment protocols when used as adjuncts to traditional root surface instrumentation. Depending upon the wavelength and settings employed, some lasers can ablate sub - gingival calculus and exert antimicrobial effects. The evidence reported to inform the current guidelines has grouped lasers into two main wavelength categories: lasers with a wavelength range of 2,780–2,940 nm and lasers with a wavelength range of 810–980 nm. Available evidence Evidence was available from five RCTs (total n = 147) with a fol - low-up of ≥6 months and a single laser application. Only RCTs reporting mean PPD changes were considered and this recom - mendation is made in the light of this approach to the systematic review.
Background
Intervention Adjunctive antimicrobial photodynamic therapy (aPDT) is an approach used to improve the antimicrobial effects of traditional root surface decontamination methods. It functions by attaching a photosensitiz - ing dye to the normally impermeable outer cell membrane of Gram- negative bacteria and then uses laser light to generate reactive oxygen species through the membrane-bound dye to locally destroy those bacteria. Available evidence Evidence was available from five RCTs ( n = 121) with a follow-up of ≥6 months and a single aPDT application. Only RCTs reporting mean PPD changes were included in the meta-analysis, and this recommen - dation is made in the light of this approach to the systematic review.
Risk of bias The majority of studies displayed unclear risk of bias.
Consistency Studies differed in terms of laser type, tip diameter, wavelength, mode of periodontal treatment, number of treated sites, population and several possible combinations of these parameters. Clinical relevance and effect size There is insufficient evidence to recommend adjunctive application of lasers to subgingival instrumentation. Balance of benefits and harm The majority of the studies did not report on potential harm/adverse effects. Economic considerations Additional costs associated with adjunctive laser therapy may not be justified.
Risk of bias The majority of studies displayed unclear risk of bias.
Consistency Substantial heterogeneity across the studies was identified, in terms of laser type, photosensitizer, wavelength, mode of periodontal treatment, number of treated sites, population and several possible combinations of these parameters.
Patient preferences Patient-reported outcomes were rarely reported.
Clinical relevance and effect size No benefits were observed with the adjunctive application of aPDT.
Applicability The majority of studies were conducted in university settings, in - cluded specifically selected populations and were undertaken in a number of different countries.
Balance of benefits and harm The majority of the studies reported on adverse events with no harm associated with the adjunctive application of aPDT. Economic considerations Additional costs associated with adjunctive laser therapy may not be justified.
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