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Consistency Substantial heterogeneity was observed in study design, interventions (laser type, photosensitizer and pre-treatment), populations studied and reported results of the studies.
R7.7. What is the efficacy of adjunctive antimicrobial photodynamic therapy in the non-surgical step of peri- implantitis treatment?
PICOS question addressed by an SR
Balance of benefit and harm No adverse effects were reported.
R7.7: Evidence-based recommendation We suggest not to use antimicrobial photodynamic therapy, adjunctively to sub-marginal instrumentation or as monotherapy, in non-surgical peri-implantitis therapy . Supporting literature (de Waal et al., 2023) Quality of evidence Very low — for adjunctive use, two 6-month RCTs, one with some concerns and one with low risk of bias; as monotherapy, no studies were considered. Grade of recommendation GradeB — # Strength of consensus : Unanimous consensus (1.9% of the group abstained due to potential CoI)
Overall certainty of the evidence Due to the heterogeneity in study design, interventions, populations studied and reported outcomes, the certainty of evidence is very low.
From evidence to recommendation — additional considerations
Acceptability There are insufficient data to support or refute the use of aPDT as adjunct to sub-marginal instrumentation in the non-surgical treatment of peri-implantitis. Feasibility The adjunctive use of aPDT following sub-marginal instrumentation is not clinically demanding or time-consuming but requires the availabil- ity of a laser. Ethical considerations There is no evidence for ethical considerations. The studied photosen- sitizers are generally considered as safe.
Background
Intervention
aPDT involves the local application of light and a photosensitizing compound. Photosensitizers are generally applied sub-marginally (in the peri-implant pocket). Photons with specific energy (wave- length) interact with the specific photosensitizer and release electrons that catalyse an oxidative reaction, which has an antibacterial effect. The rationale for application of this method in the control of peri- implantitis is based on its potential antibacterial effect on the micro- bial biofilm associated with the implant (Vohra et al., 2014).
Economic considerations The additional cost associated with aPTD may not be justified.
Available evidence
Legal considerations There are no obvious legal considerations.
Number and design of included studies Two RCTs assessing aPDT as adjunct to sub-marginal instrumentation, using either toluidine blue (66/66 patients) (Wang et al., 2019) or methy- lene blue (25/26 patients and 30/33 implants) (Alasqah, 2022), with appropriate wavelengths for the photosensitizers (635 nm for toluidine blue, 670 nm for methylene blue). As expected, no studies were found assessing aPDT as monotherapy, since aPDT cannot remove biofilm. Risk of bias One study was considered at low risk of bias, and the other had some concerns in terms of bias. Effect sizes and their clinical relevance Although both studies reported some favourable results in terms of PD reduction for aPDT as adjunct to sub-marginal instrumentation, over sub-marginal instrumentation alone, results were inconsistent and/or showed no differences for other outcome variables (BOP, MBL and/or CAL). No meta-analysis could be performed due to the limited number of studies identified and their heterogeneity.
R7.8. What is the efficacy of an adjunctive antiseptic desiccant solution in the non-surgical step of peri- implantitis treatment?
PICOS question addressed by an SR
R7.8: Evidence-based recommendation We suggest not to use a desiccant antiseptic gel, adjunctively to sub- marginal instrumentation or as monotherapy, in non-surgical peri- implantitis therapy . Supporting literature (de Waal et al., 2023) Quality of evidence Very low — one RCT with 6 months follow-up, with low risk of bias, on adjunctive use. No studies as monotherapy were considered. Grade of recommendation GradeB — # Strength of consensus : Unanimous consensus (0% of the group abstained due to potential CoI)
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